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http://www.cnn.com/2002/TECH/science/02/11/military.eye.surgery.ap/index.html[/url]

CNN.com - Military sets sights on laser tech - February 11, 2002

Military sets sights on laser tech
'Building a better warrior with technology'
February 11, 2002 Posted: 10:58 AM EST (1558 GMT)

DAYTON, Ohio (AP) -- Air Force Tech. Sgt. Ronald Neldon wore his
eyeglasses to bed for five years after he survived a terrorist attack in
Saudi Arabia.
"Do I wear the glasses or do I not sleep?" Neldon said. "I was afraid of
something happening without being able to see."
Neldon no longer sleeps while wearing his glasses because he is among
thousands of United States airmen, soldiers and sailors to receive laser
eye surgery under a program authorized by Congress two years ago. The
program is designed to free troops from eyeglasses, which can get broken
or lost in combat, or interfere with gas masks.

The military previously had prohibited laser eye surgery, in part because
of a fear it could structurally weaken the eye. However, it changed its
stance following research by the Navy.
About 17,000 soldiers, sailors and airmen have received the surgery, some
of it dating back to 1993, when the Navy research began, according to
spokesmen for all three branches.
The surgery is performed at Wright-Patterson Air Force Base in Dayton; the
Air Force Academy in Colorado Springs, Colorado; and at Lackland Air Force
Base in San Antonio, Texas. It's also provided at Army and Navy centers in
San Diego, California; Bethesda, Maryland; Fort Bragg, North Carolina;
Fort Hood, Texas; and Honolulu, Hawaii.
The surgery is strictly voluntary. In the Air Force, aviators and special
forces troops -- those most likely to see combat or wear respirators or
gas masks -- receive top priority, said Air Force Col. Leo Hurley who
performs the surgery at Wright-Patterson. Those not eligible could include
people with medical conditions such as arthritis or diabetes, which could
impair healing.
Khobar Towers attack
Neldon, a security policeman, was in bed when a truck bomb exploded
outside Khobar Towers in 1996 in Dharan, killing 19 American servicemen
and injuring 372 other people.
The blast sent his eyeglasses flying from a nightstand to the floor,
coming to rest under a locker. Neldon crawled around the dark room on his
hands and knees until he found his glasses.
"Without my glasses, I can't see," Neldon said. "You're scared."
The 39-year-old Neldon has broken five pairs of glasses while sleeping
with them, including two pairs of more durable military glasses. In
December, an Air Force doctor at Wright-Patterson performed the laser eye
surgery that made his eyeglasses unnecessary.
The smell of burning tissue during the surgery triggered flashbacks of the
bombing.

-- continued --

"I just froze," Neldon recalled. "It literally scared the hell out of me."
A technician took his hand, bringing him back to reality.
More than 3 million Americans have undergone laser eye surgery since the
U.S. Food and Drug Administration (FDA) approved its use in 1995. The
American Academy of Ophthalmology says the surgery has caused vision
problems for less than 1 percent of those receiving it.
Congress approved $15 million for the military program. Of that,
Wright-Patterson received about $2 million in July 2000 and transformed a
hospital ward into an outpatient laser surgery clinic. Treatments there
began in May.
Applying the technology
Hurley, who performs the surgery at Wright-Patterson, estimates that 40
percent of the Air Force's 350,000 troops require corrective lenses.
Hurley performed the surgery on one navigator who said he'd be virtually
blind without his glasses and feared he'd be defenseless if he had to
eject behind enemy lines.
When navigators and other airmen are forced to eject from airplanes,
glasses and contacts are ripped off by the high wind.
"If we can make them less dependent upon their glasses, we have, in
effect, made a better soldier," Hurley said. "We're building a better
warrior with technology."
Take a number
At Wright-Patterson, there's a months-long waiting list.
Patients lie on their backs in a reclining chair positioned next to a
console with a video and computer monitor. The surgeon peers through a
microscope and controls the laser with a joystick device. The procedure
takes about 15 minutes, and the patients can go home afterward.
The procedure used by the Air Force is photorefractive keratectomy, or
PRK. Surface cells of the eye are scraped away, and an ultraviolet laser
is used to flatten the surface of the cornea, improving the way the eye
focuses light.
The surface cells regenerate themselves within seven days, then it takes
up to four weeks for any blurred vision to clear.
The Air Force does not offer LASIK (laser in-situ keratomileusis) surgery,
even though it's usually less painful and recovery time is shorter.
With LASIK, the surgeon cuts a tiny flap in the cornea and folds it back,
uses a laser to flatten the surface of the cornea, and reattaches the
flap. Hurley said the flap can be displaced during combat, impairing
vision.
Although the risk of problems with laser eye surgery is low -- less than 1
percent -- in some cases there can be infection that can prevent perfect
vision, Hurley said.
"The military is willing to accept that," he said. "You've got a procedure
that's pretty good, but it's not perfect."
Pete Sepp, spokesman for the National Taxpayers Union, a watchdog group
based in Alexandria, Virginia, said the procedure should be restricted to
those who would need it in combat.
"It could be a worthy procedure, providing it were limited to personnel
where it would make a critical difference in their performance," Sepp
said.

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A word of caution about the PRK procedure:  Ask any optometrist and they will tell you that their "best" patients are PRK recipients because their vision is hardly ever corrected to the point where they don't require corrective lenses and to make matters worse the prescription is likely to change over time.  LASIK however, seems to be a more reliable procedure.  I wonder how much money was spent on the AF study, and why they chose PRK over LASIK.  Whoever made that decision will end up costing this country's taxpayers a bundle, not to mention the nuisance of the airmen when they discover that their vision will more subject to change AFTER the PRK procedure.