LASIK, PRK, Refractive Surgery in the Military
Can you trust a Department of Defense military doctor to speak the truth about LASIK and PRK?
If you experienced problems after LASIK, PRK, implantable lenses, or another form of vision correction surgery in the military, please file a report with the FDA. Read a sample of LASIK injury reports currently on file with the FDA.
Did Army Surgeon, Scott Barnes, Give Misleading Testimony?
From the article: "While Dr. Barnes spoke about "refractive surgery", his testimony in the context of a special hearing on LASIK implied that his arguments were in support of the LASIK procedure. Indeed, the Summary Minutes of the FDA hearing state that, "Dr. Barnes of the Warfighter Refractive Eye Surgery Program emphasized the importance of LASIK to the military." The FDA hearing testimony of Lt. Col. Scott Barnes is inconsistent with his recent publications." Read article
9/8/2010 update: Lt. Col. Scott Barnes states that 50% of soldiers have worse vision after LASIK than they did with their contacts. Source
Mother reports PRK-related suicide of U.S. Army veteran to the FDA - 1/14/2016
My son, [redacted by FDA], committed suicide [redacted by FDA] 2016 by a self-inflicted gunshot wound in [redacted by FDA]. He wrote suicide notes stating he killed himself because [redacted by FDA] ruined his eyes from a PRK procedure (a type of LASIK eye procedure) and thus ruined his life. My son, [redacted by FDA], was [redacted by FDA]. He was pursuing his college degree at [redacted by FDA]. His career was in petroleum engineering. He had had a problem with depression in his early teens, but had been stable without problems until after his deployment to fight in [redacted by FDA]. [redacted by FDA] had an uncomplicated LASIK surgery through [redacted by FDA] approximately 5 years ago, in 2010, with eventual deterioration of his vision in [redacted by FDA] 2015. He had a PRK procedure [redacted by FDA] 2015, by Dr. [redacted by FDA]. He had a minimal history and physical prior to the procedure. There was no information on my son's diagnosis of ptsd, anxiety, learning disability, or depression. There was no identification of the medications he was taking. Post procedure, he experienced persistent eye pain, dry eyes, and eventually loss of his eyesight to 100/20. His loss of his vision in [redacted by FDA] 2015, resulting in him not being able to visualize adequately to continue his classes and he was unable to obtain employment for his loss of vision. He repetitively saw Dr. [redacted by FDA] who continued "conservative management", despite my son deteriorating psychologically. His post operative care included a physician antagonistic to my son, with no referral to another physician, to blaming the patient for the complication, and ultimately the patient feeling hopeless and suicidal. This eye laser complication placed my son in economic distress and immediately resulted in deterioration psychologically. He wrote suicide letters stating he was killing himself due to his ruined eyes by Dr. [redacted by FDA]. I am a board certified ob/gyn, which includes board certification as a surgeon. I am horrified at the LASIK false promotion of a "safe procedure", when, in reality, lives have been destroyed with medical physicians placing monetary gains over the health care of patients. After my horrific loss of my son from his loss of vision from this PRK, LASIK procedure of his eyes, i have been even more horrified of the complications and suicides related to loss of vision from elected LASIK procedures, the devastations to lives that have incurred complications, the common complications not declared to patients, and the scant medical awareness of the patients by the physicians prior to these procedures. Link to report
Editor's note: We have identified the victim. Read his story here.
Active duty serviceman files PRK injury report with the FDA - 3/25/16
I had PRK surgery on both eyes in 2001 while on active duty, [redacted by FDA]. Had to undergo it several months later due to scarring. Noticed I had to wear sunglasses at all times after that and my night/low light vision was greatly diminished. Started getting migraine headaches. Symptoms progressed till in [redacted by FDA] 2011 I woke up in the emergency room of an apparent seizure. This occurred again in [redacted by FDA] 2012 and I was then diagnosed with seizure syndrome. My left eye lid sticks to my eyeball at night which triggers the seizure and causes extreme pain in that eye and a migraine headache. My short term memory is worsening. I am now on blood pressure meds. I have lost my job due to this. Even with the seizure meds I sometimes have painful nightly episodes of these side effects.
Military serviceman files injury report with FDA - 8/12/2014
I had PRK refractive surgery done in [redacted by FDA] 2012. I have been diagnosed with photophobia. Ever since I have had to use sunglasses pretty much all the time during day time, in sun light, artificial light, during night time, and while driving. I went to my ophthalmologist, and he said that he has never seen a situation like mine. I experience eye pain like a sharp knife stabbed me in my eyes when exposed to light for short periods of time. After exposure for around two hours I start to experience a migraine type headache that obligates me to shut down and take a 2 hour sleep along with at least 800 milligrams of Ibuprofen to get rid of the pain. My military career is being seriously affected. My time and activities with my wife and children are being affected. I am forced to wear dark sunglasses all the time, indoors and outdoors. I have read of multiple similar cases like mine after LASIK/PRK and other eye surgeries. I sometimes take off my sunglasses just to confirm that I am not imagining things, but after a few seconds there is the pain again. I think that the FDA really needs to pay attention to this matter and study or suspend this procedure until it has been further studied.
Air Force airman files PRK injury report with FDA - 2/9/2014
I got PRK surgery when I was in the Air Force and I regret it. It's been 5 years and my eyes constantly hurt and are super dry. When I wake up and my eyes open, it feels like I opened them in chlorine water. I think they are getting worse some days I cannot touch the lid of my left eye. What is worse is still need glasses so all that pain and difficult post-op pain was for nothing. Prior to my surgery, I spoke to a fellow airman who had warned me but I thought it must have been a unique situation and didn't listen to her, so I know I’m not the only one. Now I’m constantly using eyedrops and taking eye vitamins to see if that helps and it does but only so much. The drops help with the dryness, but not the pain. When a group of us were getting the surgery that day, I remember being in a room and being handed a bunch of papers, liability forms I’m sure, and not being explained anything; that day I remember asking if we had to option to getting lasik and I was told no very rudely. I was not at any point explained of the possibility life long effects of PRK.
Email from Gary G. - 12/26/2012
I'm 29 years old and I got my LASIK surgery in September of 2011, one month after my tour in Iraq was over for the military. After the first couple of weeks everything was alright. However, my right eye ended up getting infected with mycobacterium chelonae and took me almost six month to treat and cure. I had to use a fortified antibiotic shipped over to me from California. Unfortunately my health insurance doesn't cover it and I had to shell out over $150 per bottle (I had to use three to cure the disease).
Sometime in the summer of 2012 the bacteria went away but my eyes continued to tear up excessively and my vision in my right eye was blurry. At night I end up seeing halos and starbursts from street lamps and oncoming traffic headlights. After finding this website and some more research on the web I realized I have Chronic Dry Eyes from the LASIK (They preformed LASIK the first time, then PRK two weeks after the bacteria). Now I can't get my eyes to stop watering, even with the drops I usually use. I was thinking about using this new medicine called RESTASIS, but I can't find any drug store in my city that can prescribe it to me.
Study finds LASIK is not safe for military personnel - April 2012
Chin J Traumatol. 2012 Apr 1;15(2):77-80.
Laser in situ keratomileusis surgery is not safe for military personnel.
Xiao JH, Zhang MN, Jiang CH, Zhang Y, Qiu HY.
Department of Ophthalmology, Chinese PLA General Hospital, Beijing 100853, China.
Abstract
Objective: To investigate the relationship between eye injury and laser in-situ keratomileusis (LASIK) surgery in military personnel.
Methods: This retrospective study collected the data from 27 evacuation hospitals of Chinese army. All medical records of eye injuries in military personnel admitted to the 27 hospitals between January 2006 and December 2010 were reviewed. Patients'detailed information was analyzed, including the injury time, place, type, cause, as well as examination, treatment and outcome.
Results: There were 72 eye-injured patients who had been treated by LASIK before. The incidence was rising year by year. Among them, 69 patients were diagnosed with mechanical ocular injury and 3 with non-mechanical ocular injury; 29 patients had traumatic flap-related complications and 21 patients need surgery. There was statistical difference when compared with those having no refractive surgery history. Visual acuity recovered well at discharge.
Conclusion: There is a high risk of potential traumatic flap problems after LASIK and it is not recommended in army service.
Opinion Editorial - 9/22/2010
Department of Defense military LASIK surgeons are quick to assert that complications of LASIK in the military are rare. We don't buy it. We believe that servicemen are less likely than the civilian population to report problems or complain. This may be due to concerns of duty reassignment or fear of being perceived as weak.
According to Dr. Michael Allen, director of research at the University of Colorado Denver Depression Center, "In any group of men where toughness is valued, talking about anything that may be viewed as weakness goes against the grain." Source
Read about starbursts after laser eye surgery on Naval aviator Internet forum where Naval aviators' admit to hiding laser eye surgery induced vision problems. Read here
Lt. Cmdr. John B. Cason, M.D. on post-LASIK corneal neuralgia - Feb. 2012 EyeWorld
From the article: Corneal neuralgia is a newly described disease process refractive surgeons wish was mythological. Lt. Cmdr. John B. Cason, M.D., cornea, external disease, and refractive surgery, Naval Medical Center, San Diego, gave an overview of the symptoms, which many patients find excruciating. "The hallmark of this is how uncomfortable these patients are," he said. "But when you examine them, you don't see anything causing it. These patients are extremely difficult to treat; they keep coming back to your clinic. All the therapies you give them fail, and because of this, many of us think they're making it up." The pain these patients are feeling, however, is very real. Some patients are so uncomfortable and so despondent over failed treatments that they become suicidal. As one patient Dr. Cason had in fellowship said, "I want my eyes taken out or I want to die."
Military PRK patient files injury report with the FDA, "I manned up the best I knew how" - 12/13/2011
I had PRK surgery [redacted] 2011 at the [redacted]. I was told I would be back to work 6 days later with close to corrected vision. I came back for my four day check up, they took the contacts out of my eyes. I was told it would feel a little gritty for a couple of days. I didn't make it fifteen minutes down the road and I felt like I had razor blades underneath my eyelids. Being in the military, I manned up the best I knew how, put way more than prescribed numbing drops and took multiple narcotic pain pills. None of this worked. I got a hold of my surgeon and told him I would try and hold out until the next day. It was the worst pain I have ever experienced in my life. The next day I went down and they said my eyes had "sluthed." They put the contacts back and for approx two more weeks, waiting for an 8mm abrasion on both of my eyes to heal up - the civilian ophthalmologist noticed these abrasions, right before my surgeon came and looked at my eyes, and overlooked them! The abrasions never healed up, so they patched my eyes for a week and a half a piece and the abrasions finally healed up, leaving behind a lot of scar tissue, which I am still dealing with now. I've been on a long dose of steroids and I am still tapering off of them, and yet the scarring still has not gotten any better. I volunteered for this surgery to make my life better, easier, and more mission ready for my certain career field in the [redacted]. It was placed to my understanding that this was a fairly quick and short term healing procedure. But I am supposedly one of the thousands of select people that this happens to. I was told that after the six month period from my surgery, if this scarring was not healed that I could opt for the surgery again or just deal with it.
FDAweb.com editor criticizes FDA's collaboration with Department of Defense in LASIK investigation - 4/19/2010
James Dickinson, editor of FDAweb.com, wrote a letter to patient advocate, Dean Kantis, criticizing FDA's regulation of LASIK devices and the agency's inappropriate collaboration with the American Society of Cataract and Refractive Surgery (ASCRS) and Department of Defense (Navy) in the current LASIK study.
Naval aviators hide the truth about starbursts after laser eye surgery. Read here
PRK in the military results in persistent dry eyes, pain, and headaches. Reported to the FDA. Link to source.
Permanent grounding of a USAF pilot following photorefractive keratectomy.
Aviat Space Environ Med. 2010 Nov;81(11):1041-4.
Davis RE, Ivan DJ, Rubin RM, Gooch JM, Tredici TJ, Reilly CD.
Aeromedical Consultation Service, USAF School of Aerospace Medicine, 2507 Kennedy Circle, Brooks City-Base, TX 78235, USA.
Abstract
INTRODUCTION: Photorefractive keratectomy (PRK) has been extensively studied in the literature and its potential application in aircrew has not gone unnoticed. Complication rates following corneal refractive surgery (CRS), including PRK and laser in-situ keratomileusis (LASIK), remain low, with most patients achieving improved uncorrected visual acuity and reduced spectacle dependence. Overall, predictability, low complication rates, high rate of success, stability, and safety have all been cited as instrumental in the adoption of PRK in aviators. Consequently, the U.S. Air Force (USAF) approved PRK for aviators in August 2000. However, quality of vision outcomes following CRS remain a concern given the unique visual performance requirements in military aircrew, especially in austere operational environments.
CASE REPORT: This paper will present a recent case of steroid-induced ocular hypertension that is believed to have precipitated non-arteritic anterior ischemic optic neuropathy (NA-AION) associated with reduced visual performance following PRK that resulted in the first permanent grounding of a USAF pilot following CRS.
DISCUSSION: CRS has radically widened the aircrew applicant pool and has decreased spectacle dependence in war-fighters. Despite the low-risk profile of modern CRS, this case demonstrates the potential for poor outcomes from such elective surgery. Understanding these rare, but potentially devastating complications and the unique aeromedical risk factors in aircrew is paramount when considering elective vision-enhancing surgery.
Lasik's blurry vision - Salon.com 1/25/2010
From the article: Erik J. Rupard, a doctor and clinical researcher with the U.S. Army, is among those who think such scrutiny is necessary... "I saw lots of dry-eye complications in soldiers in Iraq who had undergone the procedure ostensibly because contacts are too unsafe in that dusty environment, and yet the Department of Defense has done no controlled studies to look at the cost -- human and otherwise -- of these post-refractive issues. I am a clinical researcher, and I know that Lasik, a cosmetic procedure, has never been subjected to the pre- or post-marketing scrutiny that we put even lifesaving drugs through."
Traumatic Flap Striae 6 Years After LASIK: Case Report and Literature Review.
Excerpt: Military, law enforcement, and contact sport personnel should be counseled to consider surface ablation or wear eye protection. Regarding the latter, however, we recommend that safety counseling be broadened to all patients in light of the mundane mechanisms of injury seen and the random nature of trauma. Given the growing evidence for chronic flap vulnerability and the relative youth of many LASIK recipients, long-term risks are increasingly relevant.
Source: Ursea R, Feng MT. J Refract Surg. 2009 Dec 28:1-7. doi: 10.3928/1081597X-20091209-02.
Late traumatic femtosecond LASIK flap loss
A 22-year-old male Marine had femtosecond-facilitated LASIK performed by another surgeon in our facility. The immediate postoperative period was uneventful... Eight weeks after surgery, the patient called the clinic, stating he had been struck in the right eye by a friend’s finger. He described experiencing a feeling of something on his cheek, which he had discarded. He was directed to come to the clinic immediately with a driver. He arrived within 2 hours of the injury; on examination, it was discovered that he had complete flap loss.
Source: J Cataract Refract Surg. 2009 Jun;35(6):1134-7. Visual acuity recovery after late traumatic femtosecond laser in situ keratomileusis flap loss. Thomas KE, Tanzer DJ. Naval Hospital Camp Pendleton, Camp Pendleton, and the Naval Medical Center San Diego, San Diego, California, USA. flykarin@aol.com
Death of soldier linked to hazy vision after laser eye surgery
From the article: One of the four shooters, Staff Sgt. Trevor Alders, had recently had PRK laser eye surgery. Although he could see two sets of hands "straight up," his vision was "hazy," he said.
Post-LASIK night vision problems place Army soldiers at increased risk for injury or death
From a 2008 Walter Reed Army Medical Center study:
"Soldiers experiencing postoperative glare, haze, and starbursts could be significantly impaired in their ability to perform nighttime duties, thereby reducing the ability to perform their military functions safely. In a worst-case scenario, postoperative impairment of night vision may lead to increased risk for injury or even death."
Source: Jayson et al. Effect of brimonidine tartrate 0.15% on night-vision difficulty and contrast testing after refractive surgery. J Cataract Refract Surg. 2008 Sep;34(9):1538-41.
Air Force Lt. Col. Charles D. Reilly, MD: No traumatic flap dislocations after PRK
(4/6/2009) From the article: "U.S. Air Force personnel serving in Iraq and Afghanistan who underwent photorefractive keratectomy suffered no traumatic flap dislocations in a 1-year period."
Editor's note: Of course troops who underwent PRK suffered no flap dislocations -- there's no flap in PRK. Reilly goes on to state that post-PRK haze forced some troops to leave the theater.
Military physician serving in Iraq: LASIK testimonial
I am a military physician currently serving in a Troop Medical Clinic in Iraq, where I take care of sick and wounded soldiers and marines. Although I have been an Active Duty member of the Army during the entire period of Operation Iraqi Freedom, and have volunteered for combat zone duties throughout that time, this is my first deployment. Prior to this time, I have been medically unable to deploy, due to severe dry eye syndrome which was brought on by LASIK surgery. More »
Refractive surgery in the United States Air Force
Excerpt: "In 2008 at the Joint Warfighter Refractive Surgery Center, approximately 90% of refractive surgery candidates underwent surface ablation [including PRK, laser-assisted subepithelial keratomileusis (LASEK), and epi-LASIK]... PRK remains the most common refractive surgical procedure performed in the United States Air Force."
Source: Panday VA, Reilly CD. Refractive surgery in the United States Air Force. Curr Opin Ophthalmol. 2009 Apr 24.
Editor's note: Why do you suppose that 90% of refractive surgery performed in the Air Force is PRK, not LASIK? Could it be because LASIK flaps never heal?
Retired Navy Captain Steven C. Schallhorn, M.D. rejects "stack 'em high and sell’ em cheap" allegations
From the article: Mr. Michael O’Keeffe, consultant at the Mater and Temple Street Hospitals in Dublin, claims some of these clinics operate on the basis of "stack 'em high and sell’ em cheap" and are selling what is a complex and sometimes hazardous procedure as if they were selling “cans of beans or handbags.”... Dr. Schallhorn rejected Mr. O'Keeffe's assertion that having a doctor providing all the care is the best model.
Preliminary results of photorefractive keratectomy in active-duty United States Navy personnel
Excerpts from commentary by Leo J. Maguire, MD:
"If the mission is to give all troops 20/20 uncorrected photopic visual acuity 1 year after surgery, then the mission is accomplished-- at least in the first eyes of these two Navy SEALs and 28 other Navy personnel. If the mission is to provide a service that consistently preserves optical quality and accurately corrects refractive error, then we find casualties among the volunteers and some information missing in action".
"Unfortunately, we also have the postoperative minority with severe halos, severe glare, and disabling night vision -- all in a group with relatively low myopia. One can always discontinue contact lenses, but refractive surgery is forever."
"The results are mixed. The surgery is successful in the majority of patients, but the laser still takes prisoners. Upgrades in laser design and study protocols may eliminate these problems. Until then, the Navy should maintain the regulatory guard, and continue to gather intelligence".
Source: Schallhorn SC, Blanton CL, Kaupp SE, Sutphin J, Gordon M, Goforth H Jr, Butler FK Jr. Preliminary results of photorefractive keratectomy in active-duty United States Navy personnel. Ophthalmology. 1996 Jan;103(1):5-22.