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DTH350
07-08-2008, 15:01
Good Afternoon,

I am a third-year law student with absolutely no medical expertise. I am interested to hear from those with such expertise on the topic of a new eye procedure called Implantable Contact Lenses (ICL).
I went to the eye-doc for a consultation on Lasik or PRK. He told me my corneas were too thin for the Lasik or PRK procedure but that ICL would be the optimal choice.
My internet research, along with my eye-doc, says the benefits are better visual acuity than with Lasik or PRK, the procedure is reversible if needed, and chances for dislodgment of the lens are slim-to-none.
The only negative to the procedure seems to be an increased risk of developing cataracts in the later years.
My doc says the military has approved the procedure. Of course, that does not necessarily mean that it applies to SF. It is my understanding that the regs on corrective eye surgery are constantly changing and that waivers are granted on a case by case basis. The most recent regs I found were current as of January 2008, which did not mention ICL.
My recruiter said some new regs recently came out (last week) - He is in the process of checking out the ICL matter.
While he does that, in the mean time, I am interested to learn any information, concerns, or rumors regarding the procedure and its physical effects (good and bad).
If the recruiter comes back with a thumbs-up, then I will probably opt for the surgery, assuming no one replies with concerning information or horror stories about the procedure.

Many Thanks -- DTH

Red Flag 1
07-08-2008, 17:42
So you are looking for something other than glasses or "non-implantable" contact lenses. I am not an eye doc. I am not familiar with regs re: implantable contact lenses; so I am a little out of my lane here. That having been said, I would wonder why invasive correction is a goal in this case?

When your refraction requirements change, mine have several times, does it mean yet another invasive event to correct your vision again?

RF 1

SF_BHT
07-08-2008, 18:11
So you are looking for something other that glasses or "non-implantable" contact lenses. I am not an eye doc. I am not familiar with regs re: implantable contact lenses; so I am a little out of my lane here. That having been said, I would wonder why invasive correction is a goal in this case?

When your refraction requirements change, mine have several times, does it mean yet another invasive event to correct your vision again?

RF 1

That is right and then you go in for another operation and down time. Do not forget about the higher rate of Cataracts .......:confused:

DTH350
07-08-2008, 21:05
Thanks for the replies. Invasive correction is the goal because, while my vision currently satisfies the regulatory requirements (correctable with spectacles to 20/20), without spectacles I would be a danger to myself and my team down range. I am concerned about what would happen if my glasses shattered or got knocked off - I would not be able to protect my team.
My doc said that the procedurewould only need be done once - I will have to ask him specifically about how the implantable lens works when my refraction requirements change. I will let you guys know what he says. He is supposed to contact me by the end of the week. Thanks.

SF_BHT
07-08-2008, 21:36
Thanks for the replies. Invasive correction is the goal because, while my vision currently satisfies the regulatory requirements (correctable with spectacles to 20/20), without spectacles I would be a danger to myself and my team down range. I am concerned about what would happen if my glasses shattered or got knocked off - I would not be able to protect my team.
My doc said that the procedurewould only need be done once - I will have to ask him specifically about how the implantable lens works when my refraction requirements change. I will let you guys know what he says. He is supposed to contact me by the end of the week. Thanks.

I wore glasses almost all of my career and never endangered anyone. Always had a spare pair and during operations used sport type glasses or the old NBC types that they came out with in the 80's. Was able to SL Jump, SL JM, Halo, Halo JM, waterborne Opns, Helo Ops, etc, etc and never went with out my second eyes. Do not let your glasses be a distraction. If you are corrected and in regs drive on. You can always get it done later. The procedure is fairly new and I would wait a few more years and see how it turns out.

DTH350
07-09-2008, 08:06
I wore glasses almost all of my career and never endangered anyone. Always had a spare pair and during operations used sport type glasses or the old NBC types that they came out with in the 80's. Was able to SL Jump, SL JM, Halo, Halo JM, waterborne Opns, Helo Ops, etc, etc and never went with out my second eyes. Do not let your glasses be a distraction. If you are corrected and in regs drive on. You can always get it done later. The procedure is fairly new and I would wait a few more years and see how it turns out.

Sounds like good advice to me, thanks. Good to hear that glasses didn't hinder you from high-speed schools and your missions. I'm still interested to hear what the doc has to say about subsequent procedures due to refractment requirement changes. I'll post something when I hear from him.

Red Flag 1
07-09-2008, 08:15
Advice from a surgeon friend of mine.

"Do not be the first to fully embrace the new, or the last to abandon the old".

Best of luck.

RF 1

DTH350
07-24-2008, 13:36
I spoke with the doc's assistant yesterday. It seems that as my natural sight gets worse as I age, I will, indeed, require additional procedures to implant new lenses. She said that it's not a big deal, though. Uhh...perhaps not to her being that she is the owner's wife, but I would be the one paying for it. Thanks for the advice guys.

The Reaper
07-24-2008, 13:48
Call me old fashioned, but I would not be anxious to be a guinea pig for the connection of the words "eye" and "surgery".

The Army tends to be pretty old fashioned about things like that as well.

TR

DTH350
07-24-2008, 14:04
Call me old fashioned, but I would not be anxious to be a guinea pig for the connection of the words "eye" and "surgery".

The Army tends to be pretty old fashioned about things like that as well.

TR

Roger that Sir - sticking to the spectacles for now.

Red Flag 1
07-24-2008, 14:37
I spoke with the doc's assistant yesterday. It seems that as my natural sight gets worse as I age, I will, indeed, require additional procedures to implant new lenses. She said that it's not a big deal, though. Uhh...perhaps not to her being that she is the owner's wife, but I would be the one paying for it. Thanks for the advice guys.


That the Doc did not tell you this himself is telling! As a provider, I would have told you myself.

Thank you for the feed back. Perhaps in time, this treatment option can be what cataract surgery is today for surgical vision correction.

There are folks who will leap at this without the research and deliberation you have taken. IMHO, you have done the right thing today.

As always, the best of luck!

RF 1

Doczilla
07-24-2008, 23:29
I would say get a second opinion from a different practice.

No matter what refractive procedure you have, you will need reading glasses as your eyes get older. This has to do with the elasticity of the lens, not the refraction of the cornea. There are a lot of advances in lens replacement, and currently safe implantable lenses that you can get to improve your ability to accommodate near vision. This is similar to the procedure that your doctor is recommending. It's not off the wall; we've been replacing lenses for cataracts for some years now with excellent results. I just haven't heard of doing it for refractive vision correction until now. My google-fu reveals that for extreme farsightedness, surgical lens replacement is an option. It is not FDA approved, and our clinical experience is limited. If this is the case, I'd wait a while to see how things shake out.

I got PRK surgery 1 year ago after doing a good bit of research. I read the optho textbooks, talked with the Optho flight commander and one of the other opthos at WPAFB, and sat in on a large number of procedures as well as follow-up exams. I got references from other physicians. Here's what I can tell you:

Refractive surgery is incredibly safe, particularly if you follow the doc's instructions TO THE LETTER.

Refractive surgery is better than glasses for military and tactical folks because a) you can't lose your eyeballs, or if you do, you're out of the fight anyway, and b) if you don't need glasses, you are more likely to wear appropriate protective eyewear, and that saves eyes.

PRK and LASIK are virtually identical in terms of outcomes. In PRK, the epithelium over the cornea is removed, and the surface is lasered. In LASIK, a flap is cut in the cornea, and the cornea under the flap is lasered. The flap is then laid back down. The visual correction is the same, and percentage of outcomes of 20/20 vision or better are equal. LASEK is kind of a blend between the two; instead of cutting a flap in the cornea (like LASIK), the epithelium is peeled off then laid back down after lasering the corneal surface.

PRK has longer healing times and somewhat more pain, since the epithelium is removed and then grows back like a large corneal abrasion. People deal with this differently. I took my drops, took my vitamin supplements (vitamin C is important for healing) and flaxseed oil (omega-3 fatty acids supply much of the oil in the glands of the eye. Having enough means less dry eye, which is the most common complaint about refractive surgery), and put an ice pack on my eyes, and only needed ibuprofen for the first couple of days after the procedure. Many of the patients I saw in follow-up were this way. Some didn't deal with it so well, and needed the percocet.

LASIK has relatively short healing time. Usually patients are pain free or have only mild irritation by day #2. LASIK is non-waiverable for HSLD stuff in the military such as freefall and SCUBA, but acceptable for many MOSs. Pilots get PRK. LASIK requires the cornea to be of a certain thickness. If it is too thin, they have to do PRK. I don't know for sure if lens replacement is waiverable, but I don't think it is, considering that most folks of military age wouldn't be getting it except for cataracts, which is, big surprise, not waiverable.

The big difference in side effects between older PRK/LASIK procedures and newer ones is the size of the ablation zone (area of the cornea that is shaped with the laser). The larger this is, the less halos and starbursts you get around lights. This happens when your pupil dilates to larger than the ablation zone. You then will have two different refractions, which will give you that halo effect. Different people's eyes dilate differently in low light; some people's doesn't get that large, while others' open really wide. Your optho should do a test for this (simple, noninvasive, and takes 10 seconds). Older procedures, with 3mm ablation zones, have really high rates of halos and starbursts. As you widen out the ablation zone, this drops, and at 7mm, the rate of halo side effects is around 1%.

Opthos don't know shit about pain control for the outpatient. The drops are nice, but don't let anyone give you tylenol with codiene, unless you want to still be in pain but vomiting (I do not prescribe this in my practice). Insist on percocet to have just in case the pain gets to you.

What steered me to the PRK is the fact that LASIK gives you a corneal flap which will always be there. Your epithelium does a good job of growing it back and stitching the outside back together, but it just strikes me as structurally not as sound as the PRK. There are stories of patients who got a stick in the eye that dislodged the flap. There is the possibility of an infection under the flap, though these are extremely rare.

Also, don't steal the numbing drops that they use for the exam and the procedure. Yeah, they numb your eye, but if you use them too much in a day, your corneal epithelium will haze over, and they'll have to strip the whole thing off. This is exactly as painful as it sounds.

I had my PRK done as a civilian (by the former optho flight commander from WPAFB), and it wasn't cheap. It was, however, worth every penny.

'zilla

DTH350
07-25-2008, 07:27
Doczilla,

Thanks for all the info. Initially, I was interested in PRK. The doc, however, told me my corneas are too thin for either PRK or Lasik. Thus, I was left with the option of implantable contact lenses.
I have yet to find any information on whether this is waiverable for HALO and SCUBA - I presume it is not considering neither Lasik or PRK is waiverable for these schools.
I know it is a long shot and a long road of making it to these schools, but I don't want to screw myself from the get-go by opting for an unwaiverable procedure.
I will stick with glasses for Basic and SFAS, and if I make it to training and complete the "Q", and get to complete HALO and/or SCUBA, at that point I will revisit corrective eye surgery. So we shall see (ha, no pun intended). Thanks again for all the great info.

Red Flag 1
07-25-2008, 12:03
DTH

SF BHT has been where you want to go without surgery. His insight as a QP you will not find anywhere else!

I have no credentials in eye care at all, I just did anesthesia for eye surgery. Zilla is the Doc who has had the surgery on his eyes. His suggestion of a second opinion is golden!!!

Best of luck!

RF 1