2012.10.01-ME5888

Night Carrier OperationsNight Carrier Operations

SpectaclesSpectacles

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Soft Contact Lens

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Contact LensesContact Lenses

Is LASIK OK in the Aerospace Environment?2012.10.01-ME5888

“Retention” Study785 aviators treated with PRK

>45,000 flight hours

>12,000 landings

Refractive Surgery in Naval AviatorsRefractive Surgery in Naval Aviators

2012.10.01-ME5888

ComplicationsComplications

Corneal haze (9 aviators)– Late haze with loss of best vision– Treated with steroids– Grounded but all eventually resumed flying

2012.10.01-ME5888

Students allowed into flight training that previously underwent PRK

““Accessioning” Study Accessioning” Study

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PhasePhase PrimaryPrimary Intermediate + Intermediate + AdvancedAdvanced

PRKPRK ControlControl PRKPRK ControlControl

AttritionAttrition(160(160thth-195-195thth weeks) weeks)

6.9%*6.9%* 10.7%10.7% 1.4%*1.4%* 5.1%5.1%

* Significantly lower

Student Naval Aviator Accessioning Study:Student Naval Aviator Accessioning Study:Cumulative Attrition RateCumulative Attrition Rate

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These two studies profoundly changed DoD vision standards

2012.10.01-ME5888

The “Achilles' Heel” of PRKThe “Achilles' Heel” of PRK

• Prolonged visual recovery– Minimum aviator ‘down’ time is 3 months

• LASIK offers faster recovery– Faster return to cockpit

• Qualification to land on an aircraft carrier is ONE week!

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Is the Flap Stable Enough?2012.10.01-ME5888

Gun Chamber Pressure (lbs/inGun Chamber Pressure (lbs/in22))

HaloHalo

400 knot ejection400 knot ejectionFlap DisplacementFlap Displacement

Fo

rce

Gau

ge

(lb

s)F

orc

e G

aug

e (l

bs)

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Is the Quality of Vision good Is the Quality of Vision good enough?enough?

Is the Quality of Vision good Is the Quality of Vision good enough?enough?

2012.10.01-ME5888

Change in 5% Contrast AcuityChange in 5% Contrast AcuityLo

gMA

R A

cuity

LogM

AR

Acu

ity

20/3220/32

20/4020/40

20/3220/32

20/4020/40

PRKPRK

LASIKLASIK

High myopiaHigh myopia

ModerateModerate

LowLow

2012.10.01-ME5888

Wavefront Guided LASIKWavefront Guided LASIK

2012.10.01-ME5888

Loss of ≥ 2 Lines:Conv 13%WFG 1.1%

p=0.00p=0.00

Conventional vs WFG LASIKConventional vs WFG LASIK WFGWFG provides better Contrast Acuity provides better Contrast Acuity

2012.10.01-ME5888

What is the Best What is the Best Microkeratome to Microkeratome to perform LASIK in perform LASIK in

Aviators?Aviators?

• 1 Excimer– VISX Star S4 CustomVue

• 2 Surgeons• 3 Keratomes

– Mechanical: Amadeus & Hansatome– Femtosecond: Intralase

2012.10.01-ME5888

Loss of ≥ 2 Lines:Mech 3.1%Femto 1.1%

p=0.00p=0.00

Mech Keratome vs FemtosecondMech Keratome vs Femtosecond FemtoFemto provides better Contrast Acuity provides better Contrast Acuity

2012.10.01-ME5888

Matched retrospective analysis1,000 eyes IL

1,000 eyes MKMyopia < 3.0DCyl <= 0.75D

Femtosecond-Mechanical Comparison: % of eyes achieving 20/20 UCVA

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Improving OutcomesImproving Outcomes

0.310.34

0.45

0.65

88%81%

66%

54%

0

0.25

0.5

0.75

1

1999 2001 2003 2005

WFGWFG WFGWFGFourierFourier

MS

E S

tan

dar

d D

evia

tio

n

Year

50%

100%

75%

% 20/16 U

CV

A%

20/16 UC

VA

Star S3Star S3Star S2Star S2

n = 11683 mo postop2012.10.01-ME5888

Comparison of Night Driving Performance After Wavefront-

Guided and Conventional LASIK

2012.10.01-ME5888

Preop to Postop Difference in Preop to Postop Difference in NDS Performance with GlareNDS Performance with Glare

ConventionalConventional WFG with femto flapWFG with femto flap

Pre

op

to

po

sto

p c

ha

ng

e in

fe

et

Worse after surgery

Improved after surgery

2012.10.01-ME5888

LASIKLASIK“Best of the Best”“Best of the Best”

Create the LASIK flap with a femtosecond laser

Correct refractive error with WFG ablation

2012.10.01-ME5888

Optical Express 1 mo. UCVA after iLASIK(24,928 eyes of 13,283 consecutive pts)

Age: 18 to 69 yrsSph: -0.25 to -6.0DCyl: 0.0 to -6.0D

2012.10.01-ME5888

First Naval Aviator to undergo LASIK

2012.10.01-ME5888

What Happened Next…What Happened Next…

• April 07: NASA MAB meetingApril 07: NASA MAB meeting– Recommends approval of LVC based on Recommends approval of LVC based on

improved results of WFG and femtosecond improved results of WFG and femtosecond LASIKLASIK

• May 07: May 07: USAF approvesUSAF approves LASIK LASIK– All aviation categories (tx in AF centers)All aviation categories (tx in AF centers)– Recommends WFG and femtosecond laserRecommends WFG and femtosecond laser

• Sept 07: Sept 07: NASA approvesNASA approves LASIK for LASIK for astronaut applicantsastronaut applicants– Preop +4 to -8D MSE, up to 3D cyl Preop +4 to -8D MSE, up to 3D cyl

2012.10.01-ME5888

We have entered a new era in laser vision correction

2012.10.01-ME5888