I went ahead and dug up some information that the Navy has posted, based on a NAVADMIN that I saw in Dave Shutter's post on the topic "The Navy said no!".
U.S. Navy Bureau of Medicine and Surgery
Washington, D. C.
Complete Policy for Corneal Refractive Surgery Physical Standards and Waiver Policy
http://navymedicine.med.navy.mil/PRK/refractive_surgery_information.htm
quote:
http://navymedicine.med.navy.mil/PRK/corneal_refractive_surgery_physi.htm
Corneal Refractive Surgery Physical Standards and Waiver Policy in the Navy and Marine Corps (Revised April 10, 2000).
Reference A is the Manual of the Medical Department (NAVMED P117).
Reference B is the Refractive Surgery Policy in the Navy and Marine Corps For New Accessions.
Reference C is the Photorefractive Keratectomy Policy for Diving Programs including Special Operations.
Reference D is the 1997 Navy Aeromedical Reference and Waiver Guide
Reference E is the DOD Physical Standards for Appointment, Enlistment and Induction.
POC is Capt. Charles. O. Barker, MC, MED-23B, Bureau of Medicine and Surgery, Washington, D.C.; (202) 762-3451; DSN 762
Background. Corneal refractive surgery is a surgical treatment for abnormal visual acuity. There are presently four surgical procedures: Radial Keratotomy (RK), Photorefractive Keratectomy (PRK), Laser in Situ Keratomileusis (LASIK), and Intra-Corneal Ring Implants (ICR). Civilian eye specialists are performing all procedures, but LASIK is currently the most common.
RK has been assessed by Navy ophthalmologists, who determined that RK does not produce stable visual correction in operational environments.
PRK involves no]n surgical incisions, but rather a series of fine laser ablations to re-sculpt the corneal. PRK has been extensively studied by the Navy and is currently the procedure of choice. Optimal results with PRK occur in a person who is at least 21 years old, has a stable refraction, mild to moderate nearsightedness or farsightedness and mild to moderate astigmatism.
The purpose of this message is to promulgate current corneal refractive surgery physical standards and waiver policies for active duty and reserve communities to include all new general accessions, undersea/diving/special warfare, for surface warfare, and for aviation warfare communities.
General Accessions. As indicated in Reference E, all forms of corneal refractive surgery are disqualifying for general Naval and Marine Corps duty. References (A) and (B) establish physical standards and waiver process guidelines for individuals applying for appointment, enlistment, and induction into the U.S. Navy and U.S. Marine Corps for active duty and reserves.
Corneal refractive surgery waiver requests are considered on a case by case basis. Waivers for RK will not be considered. Waivers for PRK and LASIK will be considered. Waiver requests for applicants to Special Duty communities (Undersea/Diving/Special Warfare, Surface Warfare, and Aviation Warfare) must be evaluated and recommended for approval by those communities.
Undersea/Diving/Special Warfare. Reference (C) is superseded by this message.
(1) Submarine duty: the following interim change to Chapter 15, article 15-69, paragraph (2)(B), of Reference (A) is effective immediately: (2)(B)(3) All forms of corneal surgery are disqualifying except for PRK and LASIK.
Candidates for entry into submarine duty must have a three-month waiting period following their most recent PRK or LASIK surgery prior to their qualifying examination for submarine duty. Return to full duty recommendations for personnel already qualified in submarines or assigned permanent duty to submarines will be considered when recommended by an ophthalmologist or optometrist and an undersea medical officer. Personnel must receive authorization from their commanding office prior to PRK or LASIK surgery. This provision does not pertain to new accessions to active or reserve duty who must comply with Reference B.
(2) Diving Special Warfare: The following interim change to Chapter 15, Article 15-66, paragraph (2)(C)(6) of Reference (A) is effective immediately:
(2)(C)(6) Excimer laser Photorefractive Keratectomy (PRK) is not disqualifying for Diving/Special Warfare duty. All other forms of corneal refractive surgery, including Radial Keratotomy(RK) and Laser in Situ Keratomileusis (LASIK), are disqualifying and waiver recommendations will normally not be considered.
Candidates for entry into Diving Duty, including Special Operations and Special Warfare, must have a three-month waiting period following their most recent corneal surgery prior to their qualifying examination. An ophthalmologist or optometrist and an undersea medical officer will determine when designated diving and special warfare personnel may return to full duty following corneal surgery. Personnel electing PRK must receive authorization from their commanding officer prior to the surgery. This provision does not pertain to new accessions to active duty, who must comply with reference (B).
(3) Surface warfare: All forms of corneal surgery are disqualifying except PRK and LASIK. Personnel must receive authorization from their commanding officer prior to corneal surgery.
Following corneal surgery, return to full duty recommendations will be considered for personnel being examined for surface warfare qualification, qualified surface warfare or assigned permanent duty when cleared by an ophthalmologist or optometrist and the ship's medical officer.
Sufficient post operative convalescent tie must have elapsed as evidenced by stable refractive error demonstrated by two separate examinations performed at least one month apart for this consideration to be made.
This provision does not pertain to new accessions to active duty who must comply with reference (B).
(4) Aviation Warfare. All forms of corneal surgery are disqualifying. PRK is the only procedure that will be considered for waiver. (A) air warfare new accession applicants having had PRK (civilians, NROTC, Naval Academy and enlisted accessions) may be waivered for aviation duty if they meet all the following criteria:
a. Accepted into a Navy-approved PRK study protocol for long-term follow-up
b. Pre-PRK refractive error was less than or equal to plus or minus 5.50 (total) diopters in any meridian with less than or equal to plus or minus 3.00 diopters of cylinder and anisometropia less than or equal to 3.50 diopters.
c. Civilian applicants must provide detailed pre-operative, operative, and post-operative PRK follow-up records prior to acceptance into a Navy approved PRK study.
d. At least three months have elapsed since surgery or re-treatment and evidence of stable refractive error is demonstrated by two separate examinations performed at least one month apart.
e. Meet all other applicant entrance criteria as delineated in references (A) and (D) and as specified by approved aviation PRK-study protocols.
Designated Naval aviation personnel (flying class one, flying class two, and class three designated enlisted aircrew and flight deck personnel), upon approval by their commanding officers, may seek acceptance into a Navy PRK aviation study protocol involving actual PRK surgery. A waiver to return to flight duties will be recommended if they meet all study requirements and all other physical standards as delineated in references (A) and (D).
Personnel electing the surgery must receive authorization from their commanding officer prior to the procedure.
For more information concerning corneal refractive surgery and PRK in the Navy/Marine Corps, go to http://navymedicine_dev/refractive_questions.htm
POCS are:
1. General Accessions: CMDR L. Grubb, MC, MED-25; 202 762-3482; DSN 762; email: lkgrubb@us.med.navy.mil.
2. Undersea/Diving/Special Warfare: CAPT J Murray, MC, MED-21; 202 762-3449; DSN 762; email: jwmurray@us.med.navy.mil.
3. Surface Warfare: CAPT J. Montgomery, MC, MED-22; 202 762-3466; DSN 762; email: jrmontgomery@us.med.navy.mil.
4.Air Warfare: CAPT C. Barker, MC, MED-23B; 202 762-3451; DSN 762; email: cobarker@us.med.navy.mil.
5. Reserves: LT T. Wolfkill, MSC, MED-07A; 202 762-3418; DSN 762; email: tjwolfkill@us.med.navy.mil.
Retain copy of this message until applicable changes are made in Reference (A) or are superseded by future changes.
VICE ADM R.A. Nelson, Navy Surgeon General
Corrective eye surgery questions and answers
http://navymedicine.med.navy.mil/PRK/refractive_surgery_questions_and.htm#Question%207
NAVADMIN 341/99
http://www.salts.navy.mil/ftp/pub/salts_std/bupers/bulletins/NAV99341.TXT
quote:
ADMINISTRATIVE MESSAGE
ROUTINE
R 212221Z DEC 99 ZYB MIN PSN 343512J18
FM CNO WASHINGTON DC//N00//
TO NAVADMIN
UNCLAS //N06110//
NAVADMIN 341/99
MSGID/GENADMIN/CNO N00//
SUBJ/PHOTOREFRACTIVE KERATECTOMY (PRK) SURGERY PROGRAM
/FOR ACTIVE DUTY SERVICE MEMBERS//
REF/A/DOC/BUMED MEMO/01JUN99/-/NOTAL//
REF/B/DOC/HQMC PAPER/20JUL99/-/NOTAL//
REF/C/MSG/BUMED/291330ZSEP99//
REF/D/DOC/NMCSD MEMO/27JUN97/-/NOTAL//
REF/E/DOC/BUMED P117/-/-/NOTAL//
NARR/REF A IS CNO PRK EXECUTIVE SUMMARY MEMORANDUM. REF B IS CMC PRK DECISION PAPER. REF C IS CORNEAL REFRACTIVE SURGERY PHYSICAL STANDARDS AND WAIVER POLICY. REF D IS NMC SAN DIEGO OPHTHALMOLOGY PRIORITIZATION PROTOCOL. REF E IS MANUAL OF THE MEDICAL DEPARTMENT (NAVMED P117)//
RMKS/1. CORNEAL REFRACTIVE SURGERY IS A SURGICAL TREATMENT FOR ABNORMAL VISUAL ACUITY. THERE ARE PRESENTLY FOUR SURGICAL
PROCEDURES: RADIAL KERATOTOMY (RK), PHOTOREFRACTIVE KERATECTOMY (PRK), LASER IN SITU KERATOMILEUSIS (LASIK), AND INTRA-CORNEAL RING IMPLANTS (ICR). RK HAS BEEN ASSESSED AND DOES NOT PRODUCE STABLE
VISUAL CORRECTION IN OPERATIONAL ENVIRONMENTS. PRK INVOLVES NO SURGICAL INCISIONS, BUT RATHER A SERIES OF FINE LASER ABLATIONS, RE-SCULPTING THE CORNEA. PRK HAS BEEN EXTENSIVELY STUDIED BY THE NAVY AND IS CURRENTLY THE PROCEDURE OF CHOICE. OPTIMAL RESULTS OCCUR IN A PERSON WHO IS 21 YEARS OR OLDER, HAS A STABLE REFRACTION, MILD TO MODERATE NEARSIGHTEDNESS OR FARSIGHTEDNESS, AND MILD TO MODERATE ASTIGMATISM. HOWEVER, THERE ARE OTHER FACTORS THAT MAY DISQUALIFY AN INDIVIDUAL FROM OBTAINING THE PROCEDURE. LASIK, ICR AND ANY OTHER FUTURE SURGICAL PROCEDURES WILL REQUIRE OPERATIONAL EVALUATION FOR THEIR APPLICABILITY TO NAVAL PERSONNEL.
2. REFERENCES (A) AND (B) AUTHORIZE THE USE OF PRK IN NAVY AND MARINE CORPS ACTIVE DUTY PERSONNEL. REFERENCES (C) AND (E) ARE CURRENT CORNEAL REFRACTIVE SURGERY PHYSICAL STANDARDS AND WAIVER POLICIES FOR THE NAVY AND MARINE CORPS. REFERENCE (C) IS AVAILABLE AT HTTP
DOUBLESLASH) NAVYMEDICINE.MED.NAVY.MIL.
3. REFERENCE (D) PROVIDES THE PRIORITIZATION POLICY FOR ACTIVE DUTY PERSONNEL DESIRING TO HAVE CORNEAL REFRACTIVE SURGERY. THE INTENT OF THE PRIORITIZATION PLAN IS TO ENSURE THAT THOSE ACTIVE DUTY MEMBERS WHOSE OPERATIONAL EFFECTIVENESS WOULD BE MOST ENHANCED
BY PRK ARE FIRST IN LINE FOR THE PROCEDURE. RESPONSIBLE LINE COMMANDERS WILL DETERMINE THE PRIORITY LEVEL MERITED BY INDIVIDUAL
SERVICE MEMBERS, BASED ON OPERATIONAL NEED, PROBABILITY OF ENHANCING MISSION PERFORMANCE, AND ISSUES OF PERSONAL SAFETY IN THE PERFORMANCE OF MILITARY DUTIES.
(A) PRIORITY I (HIGHEST PRIORITY) SHALL BE LIMITED TO PERSONNEL WHOSE MILITARY DUTIES, WITHOUT QUESTION, REQUIRE THEM TO FREQUENTLY
AND REGULARLY WORK IN EXTREME PHYSICAL ENVIRONMENTS THAT PRECLUDE THE SAFE USE OF SPECTACLES OR CONTACT LENSES, OR WHERE THEIR USE HAS A HIGH PROBABILITY OF COMPROMISING MISSION PERFORMANCE.
(B) PRIORITY II IDENTIFIES HIGH PRIORITY PERSONNEL WHOSE MILITARY DUTIES REQUIRE THEM TO FREQUENTLY WORK IN ADVERSE PHYSICAL
ENVIRONMENTS, WHERE PERSONAL SAFETY AND MISSION PERFORMANCE MAKE THE USE OF SPECTACLES OR CONTACT LENSES IMPRACTICAL, BUT NOT NECESSARILY INCOMPATIBLE.
(C) PRIORITY III IDENTIFIES PERSONNEL WHOSE MILITARY DUTIES DO NOT TYPICALLY EXPOSE THEM TO EXTREME PHYSICAL ENVIRONMENTS, BUT
THERE IS A REASONABLE EXPECTATION THAT THE MEMBER MAY PERIODICALLY MEET THE CRITERIA FOR PRIORITY II.
(D) PRIORITY IV IDENTIFIES PERSONNEL WHOSE MILITARY DUTIES RARELY EXPOSE THEM TO EXTREME PHYSICAL ENVIRONMENTS AND WHERE THERE IS NO REASONABLE EXPECTATION OF BEING ASSIGNED TO WORK ENVIRONMENTS THAT WOULD MAKE SPECTACLE OR CONTACT LENS USE DIFFICULT.
4. ACTIVE DUTY SERVICE MEMBERS MAY REQUEST PRK. THE MEMBER MUST BE INITIALLY SCREENED AT THE NEAREST MEDICAL TREATMENT FACILITY (MTF) BY OPHTHALMOLOGISTS/OPTOMETRISTS TO DETERMINE IF THEY MEET THE CLINICAL CRITERIA FOR PRK SURGERY. IF CLINICALLY ELIGIBLE, THE UNIT COMMANDING OFFICER MUST ENDORSE THE MEMBER'S REQUEST FOR THE PROCEDURE AND DETERMINE THE PRIORITY LEVEL (I-IV) TO BE USED IN REFERRING THE INDIVIDUAL FOR PRK SURGERY. ONCE WRITTEN APPROVAL AND PRIORITY DETERMINATION HAVE BEEN COMPLETED BY THE COMMANDING OFFICER, THE LOCAL MTF OPHTHALMOLOGIST/OPTOMETRIST WILL BE RESPONSIBLE FOR FORWARDING ALL REQUIRED DOCUMENTS TO PRK SITE COORDINATORS AND REQUESTING SCHEDULING FOR FINAL EVALUATION AND SURGERY. AT THIS TIME PRK IS AVAILABLE AT NAVAL MEDICAL CENTERS SAN DIEGO AND PORTSMOUTH. MEDICAL STAFF ASSIGNED TO THE PRK SITE ARE RESPONSIBLE FOR MAKING THE FINAL DETERMINATION OF ELIGIBILITY, PRIORITY, AND CLINICAL APPROPRIATENESS OF THE PROCEDURE. ALL COSTS OF TRAVEL, LODGING, MEALS AND OTHER MISCELLANEOUS EXPENSES ASSOCIATED WITH THE PROCEDURE MUST BE BORNE BY THE MEMBER OR THE MEMBER'S UNIT.
5. PRK FOLLOW-UP CARE WILL BE PROVIDED BY OPHTHALMOLOGISTS/OPTOMETRISTS IN SUPPORTING MILITARY MTFS CLOSEST TO THE SERVICE MEMBER'S PERMANENT DUTY STATION.
6. FOR FURTHER INFORMATION ABOUT NAVY MEDICINE'S CORNEAL SURGERY PROGRAM AND POINTS OF CONTACT GO TO HTTPDOUBLESLASH)NAVYMEDICINE.MED.NAVY.MIL/ OR CALL SAN DIEGO
CORNEAL SURGERY PROGRAM OFFICE COM (619) 524-0555/DSN 524.
7. RELEASED BY ADM JAY L. JOHNSON, CNO.//
BT
Navy & Marine Corps Medical News
MN-99-40
Oct 8, 1999
http://www.chinfo.navy.mil/navpalib/news/mednews/med99/med99040.txt
quote:
Headline: BUMED announces new policy on corneal refractive
surgery
By Lt. Jensin W. Sommer, USN, Bureau of Medicine and Surgery
WASHINGTON -- The Bureau of Medicine and Surgery recently released new corneal refractive surgery physical standards
and waiver policies for general accessions into the Navy and Marine Corps, as well as for active duty personnel currently serving in undersea/diving/special warfare, surface warfare and for air warfare communities.
The September 29 administrative message promulgates the first comprehensive policy established by BUMED concerning corneal refractive surgery to correct visual acuity that is worse than 20/20. Refractive surgery is designed to reduce or eliminate the need for glasses or contact lenses.
There are currently four types of procedures: Radial Keratotomy (RK), Photorefractive Keratectomy (PRK), Laser in-situ Keratectomy (LASIK), and Intracorneal Ring Implantation (ICR).
Under the new policy, all forms of refractive surgery are considered disqualifying for general new accessions into the Navy or Marine Corps, but can be waivered if specific eligibility criteria are met. Currently, PRK is considered
the procedure of choice for such candidates, though other procedures may be evaluated for waivers on an individual case basis. However, for applicants seeking appointment in warfare communities, PRK is the only form of refractive surgery that will be considered for waiver at this time.
This new policy has the greatest impact on the Navy and Marine Corps aviation communities. Navy and Marine aviators
will now join submariners and surface warfare officers in being able to obtain a waiver to undergo PRK surgery, although it will be on a limited basis initially. Aviators who meet the eligibility criteria for PRK surgery may elect to have the procedure if they are accepted into a Navy-
sponsored clinical study, and are granted prior permission from their commanding officers.
Personnel in Diving and Special Warfare communities do not need a waiver for corneal refractive surgery as long as the procedure performed is a PRK. They must also have prior approval from their commanding officers.
Active duty members not assigned to warfare communities can elect to have any type of corneal refractive surgery performed through the Navy, or alternatively at their own
expense in the civilian sector, as long as they receive authorization from their command. It is important for them to realize that if they have a procedure other than a PRK, and subsequently seek appointment in a warfare community, they will be considered disqualified and potentially may not be eligible for waiver consideration.
Naval Medical Center San Diego currently is the only center performing PRK surgery in the Navy. In November, Naval Medical Center Portsmouth will begin performing the procedure as well. Additional centers may be stood up in the future. The Navy PRK centers are intended to serve active duty personnel primarily in war fighting communities.
However, limited opportunities may exist at these centers to treat other active duty service members.
In addition to PRK, surgical procedures such as RK, LASIK, and Intracorneal Ring Implants (ICR) have been performed and evaluated in the civilian sector. However, civilian studies have not addressed many of the safety and efficacy issues unique to the visual needs of military personnel working in harsh operational environments. Navy
ophthalmologists, led by Cmdr. Steve Schallhorn, MC, have spent the past seven years studying RK, PRK and most recently LASIK, at NMC San Diego and Naval Health Research Center in San Diego.
“RK has been shown to lack the desired stable visual correction required for many military occupations. Numerous clinical studies on PRK have shown outstanding safety and efficacy results among personnel assigned to war fighter communities, “Schallhorn said. “LASIK, ICR and other future surgical procedures will need further evaluation before it can be determined whether they are safe and effective procedures for active duty personnel in operational environments.”
“The most significant contribution that PRK surgery offers to our active duty forces is its ability to enhance readiness and mission performance in a multitude of operational environments in which the use of glasses or
contact lenses is either impractical or may compromise the ability to safely perform required duties,” said Cmdr. Peter Custis, MC, Navy medicine’s Specialty Leader for
Ophthalmology. “For war fighters, corneal refractive surgery is not ‘cosmetic’ surgery.”
More information about the physical standards and waiver policies is available on the BUMED homepage at www.navymedicine.med.navy.mil. Under the “What’s New” section, click on “Corrective Eye Surgery Information.”
BUMED will release another message in the near future announcing the implementation of the Navy’s PRK surgery program for selected warfare communities. This program is
intended to expand current capabilities to treat war fighters. The message will identify the procedures that personnel must follow to determine if they are eligible for
surgery, the prioritization plan that will be used to establish head of the line privileges, and guidance for commanding officers, according to Custis.
Points of contact are:
For general accessions: CDR L. Grubb, (202) 762-3482
For Undersea/Diving/Special Warfare: CAPT J. Murray, (202) 762-3449
For Surface Warfare: CAPT J. Montgomery: (202) 762-3466
For Air Warfare: CAPT C. BARKER: (202) 762-3451
DSN prefix for these numbers is 762.
U.S. Navy Bureau of Medicine and Surgery
Washington, D. C.
Complete Policy for Corneal Refractive Surgery Physical Standards and Waiver Policy
http://navymedicine.med.navy.mil/PRK/refractive_surgery_information.htm
quote:
http://navymedicine.med.navy.mil/PRK/corneal_refractive_surgery_physi.htm
Corneal Refractive Surgery Physical Standards and Waiver Policy in the Navy and Marine Corps (Revised April 10, 2000).
Reference A is the Manual of the Medical Department (NAVMED P117).
Reference B is the Refractive Surgery Policy in the Navy and Marine Corps For New Accessions.
Reference C is the Photorefractive Keratectomy Policy for Diving Programs including Special Operations.
Reference D is the 1997 Navy Aeromedical Reference and Waiver Guide
Reference E is the DOD Physical Standards for Appointment, Enlistment and Induction.
POC is Capt. Charles. O. Barker, MC, MED-23B, Bureau of Medicine and Surgery, Washington, D.C.; (202) 762-3451; DSN 762
Background. Corneal refractive surgery is a surgical treatment for abnormal visual acuity. There are presently four surgical procedures: Radial Keratotomy (RK), Photorefractive Keratectomy (PRK), Laser in Situ Keratomileusis (LASIK), and Intra-Corneal Ring Implants (ICR). Civilian eye specialists are performing all procedures, but LASIK is currently the most common.
RK has been assessed by Navy ophthalmologists, who determined that RK does not produce stable visual correction in operational environments.
PRK involves no]n surgical incisions, but rather a series of fine laser ablations to re-sculpt the corneal. PRK has been extensively studied by the Navy and is currently the procedure of choice. Optimal results with PRK occur in a person who is at least 21 years old, has a stable refraction, mild to moderate nearsightedness or farsightedness and mild to moderate astigmatism.
The purpose of this message is to promulgate current corneal refractive surgery physical standards and waiver policies for active duty and reserve communities to include all new general accessions, undersea/diving/special warfare, for surface warfare, and for aviation warfare communities.
General Accessions. As indicated in Reference E, all forms of corneal refractive surgery are disqualifying for general Naval and Marine Corps duty. References (A) and (B) establish physical standards and waiver process guidelines for individuals applying for appointment, enlistment, and induction into the U.S. Navy and U.S. Marine Corps for active duty and reserves.
Corneal refractive surgery waiver requests are considered on a case by case basis. Waivers for RK will not be considered. Waivers for PRK and LASIK will be considered. Waiver requests for applicants to Special Duty communities (Undersea/Diving/Special Warfare, Surface Warfare, and Aviation Warfare) must be evaluated and recommended for approval by those communities.
Undersea/Diving/Special Warfare. Reference (C) is superseded by this message.
(1) Submarine duty: the following interim change to Chapter 15, article 15-69, paragraph (2)(B), of Reference (A) is effective immediately: (2)(B)(3) All forms of corneal surgery are disqualifying except for PRK and LASIK.
Candidates for entry into submarine duty must have a three-month waiting period following their most recent PRK or LASIK surgery prior to their qualifying examination for submarine duty. Return to full duty recommendations for personnel already qualified in submarines or assigned permanent duty to submarines will be considered when recommended by an ophthalmologist or optometrist and an undersea medical officer. Personnel must receive authorization from their commanding office prior to PRK or LASIK surgery. This provision does not pertain to new accessions to active or reserve duty who must comply with Reference B.
(2) Diving Special Warfare: The following interim change to Chapter 15, Article 15-66, paragraph (2)(C)(6) of Reference (A) is effective immediately:
(2)(C)(6) Excimer laser Photorefractive Keratectomy (PRK) is not disqualifying for Diving/Special Warfare duty. All other forms of corneal refractive surgery, including Radial Keratotomy(RK) and Laser in Situ Keratomileusis (LASIK), are disqualifying and waiver recommendations will normally not be considered.
Candidates for entry into Diving Duty, including Special Operations and Special Warfare, must have a three-month waiting period following their most recent corneal surgery prior to their qualifying examination. An ophthalmologist or optometrist and an undersea medical officer will determine when designated diving and special warfare personnel may return to full duty following corneal surgery. Personnel electing PRK must receive authorization from their commanding officer prior to the surgery. This provision does not pertain to new accessions to active duty, who must comply with reference (B).
(3) Surface warfare: All forms of corneal surgery are disqualifying except PRK and LASIK. Personnel must receive authorization from their commanding officer prior to corneal surgery.
Following corneal surgery, return to full duty recommendations will be considered for personnel being examined for surface warfare qualification, qualified surface warfare or assigned permanent duty when cleared by an ophthalmologist or optometrist and the ship's medical officer.
Sufficient post operative convalescent tie must have elapsed as evidenced by stable refractive error demonstrated by two separate examinations performed at least one month apart for this consideration to be made.
This provision does not pertain to new accessions to active duty who must comply with reference (B).
(4) Aviation Warfare. All forms of corneal surgery are disqualifying. PRK is the only procedure that will be considered for waiver. (A) air warfare new accession applicants having had PRK (civilians, NROTC, Naval Academy and enlisted accessions) may be waivered for aviation duty if they meet all the following criteria:
a. Accepted into a Navy-approved PRK study protocol for long-term follow-up
b. Pre-PRK refractive error was less than or equal to plus or minus 5.50 (total) diopters in any meridian with less than or equal to plus or minus 3.00 diopters of cylinder and anisometropia less than or equal to 3.50 diopters.
c. Civilian applicants must provide detailed pre-operative, operative, and post-operative PRK follow-up records prior to acceptance into a Navy approved PRK study.
d. At least three months have elapsed since surgery or re-treatment and evidence of stable refractive error is demonstrated by two separate examinations performed at least one month apart.
e. Meet all other applicant entrance criteria as delineated in references (A) and (D) and as specified by approved aviation PRK-study protocols.
Designated Naval aviation personnel (flying class one, flying class two, and class three designated enlisted aircrew and flight deck personnel), upon approval by their commanding officers, may seek acceptance into a Navy PRK aviation study protocol involving actual PRK surgery. A waiver to return to flight duties will be recommended if they meet all study requirements and all other physical standards as delineated in references (A) and (D).
Personnel electing the surgery must receive authorization from their commanding officer prior to the procedure.
For more information concerning corneal refractive surgery and PRK in the Navy/Marine Corps, go to http://navymedicine_dev/refractive_questions.htm
POCS are:
1. General Accessions: CMDR L. Grubb, MC, MED-25; 202 762-3482; DSN 762; email: lkgrubb@us.med.navy.mil.
2. Undersea/Diving/Special Warfare: CAPT J Murray, MC, MED-21; 202 762-3449; DSN 762; email: jwmurray@us.med.navy.mil.
3. Surface Warfare: CAPT J. Montgomery, MC, MED-22; 202 762-3466; DSN 762; email: jrmontgomery@us.med.navy.mil.
4.Air Warfare: CAPT C. Barker, MC, MED-23B; 202 762-3451; DSN 762; email: cobarker@us.med.navy.mil.
5. Reserves: LT T. Wolfkill, MSC, MED-07A; 202 762-3418; DSN 762; email: tjwolfkill@us.med.navy.mil.
Retain copy of this message until applicable changes are made in Reference (A) or are superseded by future changes.
VICE ADM R.A. Nelson, Navy Surgeon General
Corrective eye surgery questions and answers
http://navymedicine.med.navy.mil/PRK/refractive_surgery_questions_and.htm#Question%207
NAVADMIN 341/99
http://www.salts.navy.mil/ftp/pub/salts_std/bupers/bulletins/NAV99341.TXT
quote:
ADMINISTRATIVE MESSAGE
ROUTINE
R 212221Z DEC 99 ZYB MIN PSN 343512J18
FM CNO WASHINGTON DC//N00//
TO NAVADMIN
UNCLAS //N06110//
NAVADMIN 341/99
MSGID/GENADMIN/CNO N00//
SUBJ/PHOTOREFRACTIVE KERATECTOMY (PRK) SURGERY PROGRAM
/FOR ACTIVE DUTY SERVICE MEMBERS//
REF/A/DOC/BUMED MEMO/01JUN99/-/NOTAL//
REF/B/DOC/HQMC PAPER/20JUL99/-/NOTAL//
REF/C/MSG/BUMED/291330ZSEP99//
REF/D/DOC/NMCSD MEMO/27JUN97/-/NOTAL//
REF/E/DOC/BUMED P117/-/-/NOTAL//
NARR/REF A IS CNO PRK EXECUTIVE SUMMARY MEMORANDUM. REF B IS CMC PRK DECISION PAPER. REF C IS CORNEAL REFRACTIVE SURGERY PHYSICAL STANDARDS AND WAIVER POLICY. REF D IS NMC SAN DIEGO OPHTHALMOLOGY PRIORITIZATION PROTOCOL. REF E IS MANUAL OF THE MEDICAL DEPARTMENT (NAVMED P117)//
RMKS/1. CORNEAL REFRACTIVE SURGERY IS A SURGICAL TREATMENT FOR ABNORMAL VISUAL ACUITY. THERE ARE PRESENTLY FOUR SURGICAL
PROCEDURES: RADIAL KERATOTOMY (RK), PHOTOREFRACTIVE KERATECTOMY (PRK), LASER IN SITU KERATOMILEUSIS (LASIK), AND INTRA-CORNEAL RING IMPLANTS (ICR). RK HAS BEEN ASSESSED AND DOES NOT PRODUCE STABLE
VISUAL CORRECTION IN OPERATIONAL ENVIRONMENTS. PRK INVOLVES NO SURGICAL INCISIONS, BUT RATHER A SERIES OF FINE LASER ABLATIONS, RE-SCULPTING THE CORNEA. PRK HAS BEEN EXTENSIVELY STUDIED BY THE NAVY AND IS CURRENTLY THE PROCEDURE OF CHOICE. OPTIMAL RESULTS OCCUR IN A PERSON WHO IS 21 YEARS OR OLDER, HAS A STABLE REFRACTION, MILD TO MODERATE NEARSIGHTEDNESS OR FARSIGHTEDNESS, AND MILD TO MODERATE ASTIGMATISM. HOWEVER, THERE ARE OTHER FACTORS THAT MAY DISQUALIFY AN INDIVIDUAL FROM OBTAINING THE PROCEDURE. LASIK, ICR AND ANY OTHER FUTURE SURGICAL PROCEDURES WILL REQUIRE OPERATIONAL EVALUATION FOR THEIR APPLICABILITY TO NAVAL PERSONNEL.
2. REFERENCES (A) AND (B) AUTHORIZE THE USE OF PRK IN NAVY AND MARINE CORPS ACTIVE DUTY PERSONNEL. REFERENCES (C) AND (E) ARE CURRENT CORNEAL REFRACTIVE SURGERY PHYSICAL STANDARDS AND WAIVER POLICIES FOR THE NAVY AND MARINE CORPS. REFERENCE (C) IS AVAILABLE AT HTTP
DOUBLESLASH) NAVYMEDICINE.MED.NAVY.MIL.3. REFERENCE (D) PROVIDES THE PRIORITIZATION POLICY FOR ACTIVE DUTY PERSONNEL DESIRING TO HAVE CORNEAL REFRACTIVE SURGERY. THE INTENT OF THE PRIORITIZATION PLAN IS TO ENSURE THAT THOSE ACTIVE DUTY MEMBERS WHOSE OPERATIONAL EFFECTIVENESS WOULD BE MOST ENHANCED
BY PRK ARE FIRST IN LINE FOR THE PROCEDURE. RESPONSIBLE LINE COMMANDERS WILL DETERMINE THE PRIORITY LEVEL MERITED BY INDIVIDUAL
SERVICE MEMBERS, BASED ON OPERATIONAL NEED, PROBABILITY OF ENHANCING MISSION PERFORMANCE, AND ISSUES OF PERSONAL SAFETY IN THE PERFORMANCE OF MILITARY DUTIES.
(A) PRIORITY I (HIGHEST PRIORITY) SHALL BE LIMITED TO PERSONNEL WHOSE MILITARY DUTIES, WITHOUT QUESTION, REQUIRE THEM TO FREQUENTLY
AND REGULARLY WORK IN EXTREME PHYSICAL ENVIRONMENTS THAT PRECLUDE THE SAFE USE OF SPECTACLES OR CONTACT LENSES, OR WHERE THEIR USE HAS A HIGH PROBABILITY OF COMPROMISING MISSION PERFORMANCE.
(B) PRIORITY II IDENTIFIES HIGH PRIORITY PERSONNEL WHOSE MILITARY DUTIES REQUIRE THEM TO FREQUENTLY WORK IN ADVERSE PHYSICAL
ENVIRONMENTS, WHERE PERSONAL SAFETY AND MISSION PERFORMANCE MAKE THE USE OF SPECTACLES OR CONTACT LENSES IMPRACTICAL, BUT NOT NECESSARILY INCOMPATIBLE.
(C) PRIORITY III IDENTIFIES PERSONNEL WHOSE MILITARY DUTIES DO NOT TYPICALLY EXPOSE THEM TO EXTREME PHYSICAL ENVIRONMENTS, BUT
THERE IS A REASONABLE EXPECTATION THAT THE MEMBER MAY PERIODICALLY MEET THE CRITERIA FOR PRIORITY II.
(D) PRIORITY IV IDENTIFIES PERSONNEL WHOSE MILITARY DUTIES RARELY EXPOSE THEM TO EXTREME PHYSICAL ENVIRONMENTS AND WHERE THERE IS NO REASONABLE EXPECTATION OF BEING ASSIGNED TO WORK ENVIRONMENTS THAT WOULD MAKE SPECTACLE OR CONTACT LENS USE DIFFICULT.
4. ACTIVE DUTY SERVICE MEMBERS MAY REQUEST PRK. THE MEMBER MUST BE INITIALLY SCREENED AT THE NEAREST MEDICAL TREATMENT FACILITY (MTF) BY OPHTHALMOLOGISTS/OPTOMETRISTS TO DETERMINE IF THEY MEET THE CLINICAL CRITERIA FOR PRK SURGERY. IF CLINICALLY ELIGIBLE, THE UNIT COMMANDING OFFICER MUST ENDORSE THE MEMBER'S REQUEST FOR THE PROCEDURE AND DETERMINE THE PRIORITY LEVEL (I-IV) TO BE USED IN REFERRING THE INDIVIDUAL FOR PRK SURGERY. ONCE WRITTEN APPROVAL AND PRIORITY DETERMINATION HAVE BEEN COMPLETED BY THE COMMANDING OFFICER, THE LOCAL MTF OPHTHALMOLOGIST/OPTOMETRIST WILL BE RESPONSIBLE FOR FORWARDING ALL REQUIRED DOCUMENTS TO PRK SITE COORDINATORS AND REQUESTING SCHEDULING FOR FINAL EVALUATION AND SURGERY. AT THIS TIME PRK IS AVAILABLE AT NAVAL MEDICAL CENTERS SAN DIEGO AND PORTSMOUTH. MEDICAL STAFF ASSIGNED TO THE PRK SITE ARE RESPONSIBLE FOR MAKING THE FINAL DETERMINATION OF ELIGIBILITY, PRIORITY, AND CLINICAL APPROPRIATENESS OF THE PROCEDURE. ALL COSTS OF TRAVEL, LODGING, MEALS AND OTHER MISCELLANEOUS EXPENSES ASSOCIATED WITH THE PROCEDURE MUST BE BORNE BY THE MEMBER OR THE MEMBER'S UNIT.
5. PRK FOLLOW-UP CARE WILL BE PROVIDED BY OPHTHALMOLOGISTS/OPTOMETRISTS IN SUPPORTING MILITARY MTFS CLOSEST TO THE SERVICE MEMBER'S PERMANENT DUTY STATION.
6. FOR FURTHER INFORMATION ABOUT NAVY MEDICINE'S CORNEAL SURGERY PROGRAM AND POINTS OF CONTACT GO TO HTTP
DOUBLESLASH)NAVYMEDICINE.MED.NAVY.MIL/ OR CALL SAN DIEGOCORNEAL SURGERY PROGRAM OFFICE COM (619) 524-0555/DSN 524.
7. RELEASED BY ADM JAY L. JOHNSON, CNO.//
BT
Navy & Marine Corps Medical News
MN-99-40
Oct 8, 1999
http://www.chinfo.navy.mil/navpalib/news/mednews/med99/med99040.txt
quote:
Headline: BUMED announces new policy on corneal refractive
surgery
By Lt. Jensin W. Sommer, USN, Bureau of Medicine and Surgery
WASHINGTON -- The Bureau of Medicine and Surgery recently released new corneal refractive surgery physical standards
and waiver policies for general accessions into the Navy and Marine Corps, as well as for active duty personnel currently serving in undersea/diving/special warfare, surface warfare and for air warfare communities.
The September 29 administrative message promulgates the first comprehensive policy established by BUMED concerning corneal refractive surgery to correct visual acuity that is worse than 20/20. Refractive surgery is designed to reduce or eliminate the need for glasses or contact lenses.
There are currently four types of procedures: Radial Keratotomy (RK), Photorefractive Keratectomy (PRK), Laser in-situ Keratectomy (LASIK), and Intracorneal Ring Implantation (ICR).
Under the new policy, all forms of refractive surgery are considered disqualifying for general new accessions into the Navy or Marine Corps, but can be waivered if specific eligibility criteria are met. Currently, PRK is considered
the procedure of choice for such candidates, though other procedures may be evaluated for waivers on an individual case basis. However, for applicants seeking appointment in warfare communities, PRK is the only form of refractive surgery that will be considered for waiver at this time.
This new policy has the greatest impact on the Navy and Marine Corps aviation communities. Navy and Marine aviators
will now join submariners and surface warfare officers in being able to obtain a waiver to undergo PRK surgery, although it will be on a limited basis initially. Aviators who meet the eligibility criteria for PRK surgery may elect to have the procedure if they are accepted into a Navy-
sponsored clinical study, and are granted prior permission from their commanding officers.
Personnel in Diving and Special Warfare communities do not need a waiver for corneal refractive surgery as long as the procedure performed is a PRK. They must also have prior approval from their commanding officers.
Active duty members not assigned to warfare communities can elect to have any type of corneal refractive surgery performed through the Navy, or alternatively at their own
expense in the civilian sector, as long as they receive authorization from their command. It is important for them to realize that if they have a procedure other than a PRK, and subsequently seek appointment in a warfare community, they will be considered disqualified and potentially may not be eligible for waiver consideration.
Naval Medical Center San Diego currently is the only center performing PRK surgery in the Navy. In November, Naval Medical Center Portsmouth will begin performing the procedure as well. Additional centers may be stood up in the future. The Navy PRK centers are intended to serve active duty personnel primarily in war fighting communities.
However, limited opportunities may exist at these centers to treat other active duty service members.
In addition to PRK, surgical procedures such as RK, LASIK, and Intracorneal Ring Implants (ICR) have been performed and evaluated in the civilian sector. However, civilian studies have not addressed many of the safety and efficacy issues unique to the visual needs of military personnel working in harsh operational environments. Navy
ophthalmologists, led by Cmdr. Steve Schallhorn, MC, have spent the past seven years studying RK, PRK and most recently LASIK, at NMC San Diego and Naval Health Research Center in San Diego.
“RK has been shown to lack the desired stable visual correction required for many military occupations. Numerous clinical studies on PRK have shown outstanding safety and efficacy results among personnel assigned to war fighter communities, “Schallhorn said. “LASIK, ICR and other future surgical procedures will need further evaluation before it can be determined whether they are safe and effective procedures for active duty personnel in operational environments.”
“The most significant contribution that PRK surgery offers to our active duty forces is its ability to enhance readiness and mission performance in a multitude of operational environments in which the use of glasses or
contact lenses is either impractical or may compromise the ability to safely perform required duties,” said Cmdr. Peter Custis, MC, Navy medicine’s Specialty Leader for
Ophthalmology. “For war fighters, corneal refractive surgery is not ‘cosmetic’ surgery.”
More information about the physical standards and waiver policies is available on the BUMED homepage at www.navymedicine.med.navy.mil. Under the “What’s New” section, click on “Corrective Eye Surgery Information.”
BUMED will release another message in the near future announcing the implementation of the Navy’s PRK surgery program for selected warfare communities. This program is
intended to expand current capabilities to treat war fighters. The message will identify the procedures that personnel must follow to determine if they are eligible for
surgery, the prioritization plan that will be used to establish head of the line privileges, and guidance for commanding officers, according to Custis.
Points of contact are:
For general accessions: CDR L. Grubb, (202) 762-3482
For Undersea/Diving/Special Warfare: CAPT J. Murray, (202) 762-3449
For Surface Warfare: CAPT J. Montgomery: (202) 762-3466
For Air Warfare: CAPT C. BARKER: (202) 762-3451
DSN prefix for these numbers is 762.
