Refractive surgery and protective eyewear in the military

Abstract

We have seen extensive media coverage of the remarkable young men and women who go in harm’s way in service to our country. It is estimated that up to one third of the 1 million active duty Army, Navy, and Air Force service members require corrective lenses. Operational demands in the military present distinct disadvantages to the soldier, sailor, or airman wearing corrective lenses. Glasses can get broken, lost, and clouded by sand, dust, rain, or mist, and are often incompatible with sophisticated helmet-mounted targeting devices, night vision goggles (NVGs), and other combat gear. Although contact lenses offer a potential advantage over glasses, they have problems of their own, particularly the inability to maintain proper lens hygiene. Despite a Department of Defense policy prohibiting contact lenses in combat and field environments such as Kuwait and Iraq, soldiers, marines and airmen continue to wear them in the field. As a result, more than 60 service members developed contact lens–related corneal ulcers/infiltrates in Iraq between April and September 2003 (Madigan, unpublished data). The applicant pool for military aviation programs has decreased to dangerous levels in recent years. Refractive error is the most common disqualifier for potential applicants who fail to meet flight medical standards. Because of a mean myopic shift of approximately 1 diopter (D) from freshman to senior year, documented in the mid-1980s at the Air Force Academy and at West Point, a young man or woman may enroll at one of the military academies or the Reserve Officer Training Corps hoping for a career in aviation, only to fall outside the proscribed refractive range by graduation. A safe and effective refractive procedure would clearly present a valuable option. Before refractive surgery was accepted as an organizational policy in the Armed Forces, it had to demonstrate appropriate levels of efficacy, predictability, and safety. Radial keratotomy was never an approved alternative to corrective lenses in the Armed Forces due to concerns over structural integrity and fluctuating vision at altitude. No branch of service, with