Warfighter Refractive Eye Surgery (LASIK Clinic)

Refractive surgery program providing PRK and LASIK surgery to eligible combat arms and non-combat arms soldiers.

Eligibility

All active-duty Soldiers (Army, Navy, Air Force, or Marines) with 18 months remaining on active duty order are eligible for refractive surgery under the WRESP if they meet the following criteria:

• Approval by Commanding Officer (rank of O-3 or above)
• Regular Active Army must have at least 18 month remaining on active duty at the time of enrollment (or in conjunction with an executed reenlistment action)
• National Guard and Reserve Soldiers are NOT eligible for treatment unless they have been activated and have at least 18 months on current Active duty orders at the time of enrollment.
• No adverse/Flagged personnel actions pending.
• At least 18 years of age
• Ability to meet all pre-operative and post-operative appointments

If you do not need glasses or contact lenses to drive a car, you are not a candidate for refractive eye surgery because your uncorrected vision is too good. Certain individuals are poor candidates for refractive surgery & will be advised so after the pre-operative evaluation. 

Priorities

Category 1: Any combat arms soldier and any deploying soldier regardless of specialty.

Category 2: Non-combat arms soldiers who are not deploying are treated on a space-available basis.

How To Enroll For Surgery

• Download DA FORM 4700 Commander's Authorization Letter for Refractive (LASIK) Surgery.
• Have your commander complete & sign the letter. Unit commanders with questions about Lasik surgery  can contact Refractive Surgery Center Chief at  (254) 286 - 7962. 
• Hand-carry the Commander's memorandum, ERB/ORB and your glasses to the Ophthalmology Clinic on the second floor of the Carl R. Darnall Army Medical Center. At that time, you will be scheduled a pre-operative evaluation. If appointments are full, you will be placed on a wait list according to the date you returned your signed Commander's memorandum.
• Contact lens wearers must stop wearing their contact lenses at least 3 weeks prior to the pre-operative evaluation.

Background

Soldiers perform duties in a wide variety of environments that are poorly suited to wearing glasses or contact lenses. Operating complicated sighting systems, wearing protective masks or night vision goggles, working in rain, mud & sand present challenges to those dependent on corrective lenses. To increase combat readiness, the Department of Defense has established the Warfighter Refractive Eye Surgery Program (WRESP) which allows eligible active-duty soldiers to receive laser refractive eye surgery.

The goal is to minimize or eliminate the need to wear corrective eyewear. Surveys from redeploying soldiers who had refractive surgery before deployment praised the surgery as increasing their combat effectiveness & overall confidence to perform the mission. Any surgical procedure involves risk & refractive surgery is completely voluntary. No one can be coerced into having refractive surgery due to the 'needs of the service' or to fill a quota.

Introduction to LASIK and PRK

The most popular eye surgery to correct vision problems in the United States is Laser Assisted In-Situ Keratomileusis (LASIK). In LASIK, the doctor uses a tiny blade (keratome) or a laser (Intralase) to cut a flap in the outermost layer of the cornea. The flap is folded back, allowing a computer-guided laser to reshape the underlying cornea. This reshaping is called photoablation. The flap is then repositioned on the ablated cornea. Most patients recover quickly from this procedure, often seeing well without glasses within three days.

PRK stands for Photorefractive Keratectomy. PRK reshapes the surface of the cornea via photoablation just like LASIK, however, no flap is created. Instead, the surgeon removes the superficial layer of the cornea with a brush, then fires the laser to reshape the underlying cornea. A contact lens is then placed & the superficial epithelial cells grow back over the ablated cornea in 3-5 days. PRK has a longer recovery time but most patients are functional within one week from surgery. Vision will continue to improve over the next few weeks.

The surgery is performed by an ophthalmologist, a medical doctor with special training in diseases & surgery of the eye. Optometrists are specialists in the treatment of eye & vision disorders & actively manage the care of soldiers before & after laser surgery, but do not perform surgery.

After refractive surgery, a strict regimen of medications is prescribed, as is a physical profile, to optimize healing of & minimize injury to the healing eyes. A few days of quarters is recommended after surgery. PRK patients are given pain medications to minimize post-operative discomfort, however, rare patients experience significant pain for several days following surgery. LASIK usually causes pain for only one or two days. Driving vision often returns only a few days after either surgery.

By eliminating the need for corrective glasses, refractive surgery leaves the soldier vulnerable to projectile objects that could injure the naked eye. For this reason, use of protective eyewear is essential following refractive surgery & is provided by our clinic to those soldiers who have not received it from their unit.

Intraocular Collamer Lens (ICL) Surgery

ICL surgery is the latest surgical option to come to Fort Hood Eye, offered to those who may not be eligible for PRK or LASIK. By implanting a lens into the eye, between the iris & one's natural lens, we can eliminate near-sightedness in many soldiers who previously would not have been able to have refractive surgery. Visual recovery is fast & pain is minimal after ICL surgery. One is nondeployable for only 30 days & receives 4 days of quarters after ICL surgery. Currently, ICL surgery requires making one or two holes in the upper iris with a laser at least one week prior to implantation of the ICLs into the eyes which necessitates one or two more preoperative appointments than PRK or LASIK, but the visual outcome is often similar, if not better, than one achieves after PRK or LASIK.

Surgery, Follow-Up, and Deployment

It is crucial for soldiers & authorizing commanders to be aware of the requirements surrounding refractive surgery in order to plan for training & deployment.

Before refractive eye surgery, you must have:

• A signed commander's letter permitting you to have refractive eye surgery.
• Eyeglasses (or prescriptions) that are at least one year old.
• Pre-operative evaluation with complete dilated eye exam by our optometrist (~2 hours).
• Group & individual counseling with an ophthalmologist that reviews your chart. This appointment generally lasts the entire morning or afternoon. Additional or repeat tests may be performed to ensure safe surgery.

PRK or LASIK generally lasts 10-20 minutes per patient, but you may be in the clinic the entire morning or afternoon, depending on the number of soldiers being treated that day. After surgery you must make:

• Post-op appointments one day, one week & one month after LASIK.
• Post-op appointments one week, one month & three months after PRK.
• After LASIK you get a 6-week nondeployable profile.
• After PRK you get a 3-month nondeployable profile.

Profiles are given to optimize healing & minimize injury to the eyes after surgery. We expect units to adhere to the profile's restrictions. For 30 days after surgery, soldiers should not live in tents, work in sunny, dusty or windy environments, do organized PT, swim, wear protective mask or face paint, fire weapons or drive military vehicles. Also, when in sunny or bright environs, soldiers should be allowed to wear sunglasses at all times for 90 days after surgery to minimize the risk of corneal scarring & hazy vision.

After PRK most soldiers require 90 days of follow-up prior to deployment, but occasionally soldiers may be released after 60 days if their treatment was low & healing looks good. The post-op appointments are necessary to ensure refractive stability & prevent deploying soldiers who are having rare complications. Again, most soldiers heal by the time the profile expires, but commanders must understand rare complications or slow healers exist; these outliers may require more frequent or longer follow-up.

For more information send us an email usarmy.hood.medcom-crdamc.mbx.lasik-web@health.mil .