ABSTRACT
INTRODUCTION: Photorefractive keratectomy (PRK) has been extensively studied in the literature and its potential application in aircrew has not gone unnoticed. Complication rates following corneal refractive surgery (CRS), including PRK and laser in-situ keratomileusis (LASIK), remain low, with most patients achieving improved uncorrected visual acuity and reduced spectacle dependence. Overall, predictability, low complication rates, high rate of success, stability, and safety have all been cited as instrumental in the adoption of PRK in aviators. Consequently, the U.S. Air Force (USAF) approved PRK for aviators in August 2000. However, quality of vision outcomes following CRS remain a concern given the unique visual performance requirements in military aircrew, especially in austere operational environments. CASE REPORT: This paper will present a recent case of steroid-induced ocular hypertension that is believed to have precipitated non-arteritic anterior ischemic optic neuropathy (NA-AION) associated with reduced visual performance following PRK that resulted in the first permanent grounding of a USAF pilot following CRS. DISCUSSION: CRS has radically widened the aircrew applicant pool and has decreased spectacle dependence in war-fighters. Despite the low-risk profile of modern CRS, this case demonstrates the potential for poor outcomes from such elective surgery. Understanding these rare, but potentially devastating complications and the unique aeromedical risk factors in aircrew is paramount when considering elective vision-enhancing surgery.
Subject(s)
Aerospace Medicine , Fluorometholone/adverse effects , Glucocorticoids/adverse effects , Optic Neuropathy, Ischemic/chemically induced , Photorefractive Keratectomy/adverse effects , Color Vision Defects/chemically induced , Elective Surgical Procedures/adverse effects , Humans , Male , Middle Aged , Military Personnel , Occupational HealthSubject(s)
Eye Injuries/prevention & control , Eye Protective Devices , Eyeglasses , Occupational Health , Vision, Ocular/physiology , Accidents, Occupational/prevention & control , Catalogs, Commercial as Topic , Humans , Lens, Crystalline/anatomy & histology , Lens, Crystalline/pathology , Occupational Exposure/prevention & control , Refractive Errors/pathology , Refractive Errors/therapy , Safety Management , United States , Vision ScreeningSubject(s)
Occupational Health , Refractive Surgical Procedures , Accidents, Occupational/prevention & control , Contact Lenses , Humans , Keratomileusis, Laser In Situ , Keratotomy, Radial/methods , Lasers, Excimer , Lenses, Intraocular , Photorefractive Keratectomy , Refractive Errors/physiopathology , Refractive Errors/therapy , Vision Screening , Work Capacity EvaluationABSTRACT
Prior to 1967, military aviators who developed visually significant cataracts that affected visual performance were grounded. Those that ultimately required surgical removal were permanently grounded because of significant optical effects post-operatively. With the advent of contact lenses, a limited number of aircrew were returned to the cockpit because of improved optical factors provided by contacts post-cataract surgery. However, development of the intraocular lens (IOL) in the 1970s marked a major technological breakthrough that provided the potential to restore post-cataract surgical vision to near normal conditions. This case report is the first known occurrence of ejection from a high performance militaryaircraft by an aviator with an IOL. The success and stability of the IOL through this event provided additional clinical and operational information relative to the overall USAF experience with certain types of IOL approved for use in USAF aircrew. The aviator also sustained unexpected corneal foreign bodies due to the canopy fragmentation system.
