Permanent grounding of a USAF pilot following photorefractive keratectomy.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
Aeromedical Consultation Service, USAF School of Aerospace Medicine, 2507 Kennedy Circle, Brooks City-Base, TX 78235, USA.
Ryan E
RE
Davis
Douglas J
DJ
Ivan
Richard M
RM
Rubin
John M
JM
Gooch
Thomas J
TJ
Tredici
Charles D
CD
Reilly
D000337:Aerospace Medicine; D003117:Color Vision Defects / Q000139:chemically induced; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005469:Fluorometholone / Q000009:adverse effects*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D016272:Occupational Health; D018917:Optic Neuropathy, Ischemic / Q000139:chemically induced*; D018903:Photorefractive Keratectomy / Q000009:adverse effects*
D005938:Glucocorticoids; D005469:Fluorometholone