Photorefractive Keratectomy - Aviator Usage

Aviator Usage

Operation of an aircraft is a visually demanding activity performed in an environment that is not always user friendly. Currently, over 50% of the civilian pilot population uses some form of visual correction. Aviators considering PRK should know that clinical trials claiming success rates of 90% or higher are based on criteria of patients' post-operative refractive errors of 20/40 or better, not 20/20 or better, uncorrected visual acuity.

Some PRK patients have reported dissatisfaction with their vision under low ambient lighting (dusk/nighttime) conditions. Pilots who experience postoperative vision problems could be further compromised by the variations in lighting common to the aviation environment. In addition, exposure to intense UV radiation has been associated with late-onset corneal haze and recurrence of myopia.

The US Federal Aviation Administration will consider applicants with PRK once they are fully healed and stabilized, provided there are no complications and all other visual standards are met. Pilots should be aware, however, that potential employers, such as commercial airlines and private companies, may have policies that consider refractive surgery a disqualifying condition. Also, civilians who wish to fly military aircraft should know that there are restrictions on those who have had corrective surgery. The Army now permits flight applicants who have undergone PRK or LASIK. Uncomplicated, successful corneal refractive surgery does not require a waiver and is noted as information only. The Navy and Marines will routinely grant a waiver for pilots or student naval aviators to fly after PRK, assuming preoperative standards are met, no complications in the healing process were encountered and passing their standard vision tests. LASIK is currently under study for the Navy, however only current Naval Aviators can be admitted into the study. In one study, 967 of 968 naval aviators having PRK returned to duty involving flying after the procedure. In fact, the U.S. Navy now offers free PRK surgery at the National Naval Medical Center to Naval Academy Midshipmen who intend to pursue career paths requiring good uncorrected vision, including flight school and special forces training. The U.S. Air Force approves the use of PRK and LASIK. Since 2000 the USAF has conducted PRK for aviators at the Wilford Hall Medical Center. More airmen were allowed over the years and in 2004 the USAF approved Lasik for aviators, with limits on the type of aircraft they could fly. Then in 2007 those limits were lifted. Most recently in 2011 the USAF expanded the program, making it easier for more airmen to qualify for the surgery. Current airmen (Active Duty and Air Reserve Components who are eligible) are authorized surgery at any DOD Refractive Surgery Center. Those airmen not eligible, are still able to get the surgery done at their own expense by a civilian surgeon, but must first be approved (Approval is based on the same USAF-RS program). Others that do not fall into those categories (i.e. applicants who are seeking a pilot slot) can still elect to have the surgery done, but must follow the criteria in accordance with the USAF Waiver Guide. Those applicants will be evaluated at the ACS during their Medical Flight Screening appointment to determine if they meet waiver criteria. Applicants are strongly encouraged to read the references contained within this article as information obtained from sources other than those listed could lead to disqualification for a pilot candidate.

In the majority of patients, PRK has proven to be a safe and effective procedure for the correction of myopia. PRK is still evolving with other countries currently using refined techniques and alternative procedures. Many of these procedures are under investigation in the U.S. Given that PRK is not reversible, a patient considering PRK is recommended to contact an eye-care practitioner for assistance in making an informed decision concerning the potential benefits and liabilities that may be specific to him or her.