Refractive surgery in the military

June 2004

An article by Drs William Madigan and Kraig Bower in the May 2004 issue of the medical journal Ophthalmology has outlined the application of refractive surgery and protective eyewear in the military. The article estimates that 35,000 personnel in the United States Army, Navy, and Air Force have had laser vision correction since the inception of its Warfighter Refractive Eye Surgery Program in 2000. The majority of treatments have been for low and moderate myopia, and about one-third of the cases have received LASIK treatment and the rest have been surface ablations (mostly PRK). In the fiscal year 2003 the Army treated 15,401 eyes of 8,449 soldiers. After surgery, 86% of cases attained unaided vision of 20/20 or better, and 98% attained 20/40 or better (i.e. they could pass the drivers licence vision test without needing glasses). One study evaluated patients under a full range of night-sky conditions using near vision goggles, and found that visual performance after PRK surgery equaled or exceeded visual performance before surgery when spectacles had been worn.

Refractive surgery for active duty personnel provides certain advantages over glasses, e.g. glasses can be broken or lost, they can be clouded by sand, dust, or rain, and they can interfere with sophisticated helmet-mounted targeting devices, night vision goggles, and other combat gear. Contact lenses can avoid some of these problems, but they too have drawbacks, particularly in relation to difficulties with maintaining proper lens hygiene in the field, which has led to numerous cases of corneal infection. Nevertheless, although corrective eyewear is impractical in field situations, the military is not seeking to eliminate eyewear altogether -- protective eyewear is still required to reduce the risk of eye injury from small fragmentation projectiles, particularly in situations where terrorist bomb attacks are likely to be encountered. The military has developed wraparound polycarbonate lenses designed to block the force of a 22-calibre bullet from 20 feet, and this armour is now a standard supply item issued to every soldier who goes through the Warfighter program.

The article concludes by saying that further research is underway to define the contributions that refractive surgery can make to the military, for example, the ability of wavefront laser technology to reduce optical imperfections in the eye opens the exciting possibility of achieving better than 20/20 vision while at the same time improving night vision for personnel on active duty.