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2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

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2012.10.01-ME5888
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Page 1: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

2012.10.01-ME5888

Page 2: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Night Carrier OperationsNight Carrier Operations

Page 3: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

SpectaclesSpectacles

2012.10.01-ME5888

Page 4: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Soft Contact Lens

2012.10.01-ME5888

Page 5: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Contact LensesContact Lenses

Page 6: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Is LASIK OK in the Aerospace Environment?2012.10.01-ME5888

Page 7: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 8: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 9: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Students allowed into flight training that previously underwent PRK

““Accessioning” Study Accessioning” Study

2012.10.01-ME5888

Page 10: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

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

2012.10.01-ME5888

Page 11: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

These two studies profoundly changed DoD vision standards

2012.10.01-ME5888

Page 12: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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!

2012.10.01-ME5888

Page 13: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Is the Flap Stable Enough?2012.10.01-ME5888

Page 14: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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)

2012.10.01-ME5888

Page 15: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

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

Page 16: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 17: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Wavefront Guided LASIKWavefront Guided LASIK

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Page 18: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 19: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 20: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 21: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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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Page 22: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

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

Page 23: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

Comparison of Night Driving Performance After Wavefront-

Guided and Conventional LASIK

2012.10.01-ME5888

Page 24: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 25: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

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Page 26: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

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Page 27: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

First Naval Aviator to undergo LASIK

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Page 28: 2012.10.01-ME5888. Night Carrier Operations Spectacles 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

Page 29: 2012.10.01-ME5888. Night Carrier Operations Spectacles 2012.10.01-ME5888.

We have entered a new era in laser vision correction

2012.10.01-ME5888


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