DR. JOSEPH DELLO RUSSO

In early November, the Navy allowed, for the first time, to four of its aviators to undergo LASIK surgery with the IntraLase method. Although LASIK is not yet officially approved in the U.S. military aviation community, this is a first step in that direction. In the past, concern about the harsh aviation environment has prevented the use of LASIK as a method to treat the eyes of military pilots, Dr Dello Russo explained. High altitude, dry air, and wind blast are just some of the extreme conditions that these pilots encounter, but years of LASIK trials on non-aviation personnel encouraged the Bureau of Naval Medicine. 

The first Navy aviator who underwent the LASIK procedure was Marine Capt. Michael Oginsky, an FA 18/D weapons and sensor officer with VMFAT 101 at U.S. Marine Corps Air Station Miramar. Within just four hours, Oginsky’s vision became 20/20. At the 24-hour mark, his vision exceeded 20/20. There are four additional aviators scheduled to take part in the first step of the program. 

According to Capt. Steve Schallhorn, Navy Program manager for Refractive Surgery, “While LASIK has been around for many years and is a common elective procedure; this is a significant first in the aeromedical field. Wavefront guided LASIK using the IntraLase Method represents the best-of-the-best and is a truly exciting advancement for critical Navy personnel whose sight is of utmost importance in their military duties.”

EDITOR’S NOTE: Readers of this blog will remember that the Intralase laser was first introduced by the pioneering Dr Dello Russo of New York and Dr Christenberry of North Carolina in February of 2002. These two doctors were instrumental in establishing the laser as safer as well as superior to a $25 blade to make the flap in lasik. They pioneered the advantages and wrote in publications and spoke at national professional meetings of the safety of the Intralase technology. ”It took a good two years for the tide to turn against the blade and here we are almost five years later with 40 % of all flaps now being made without a blade, with the number growing”, says Dr Dello Russo. Dello Russo also noted that “it is becoming the standard of care so much so that even the very conservative military services finally prefer the Intralase over a blade.”

A recent article in the Washington Post refers to soldiers choosing one of the above procedures instead of LASIK. What’s the difference?

There are actually two types of laser vision corrections surgeries. One with a flap, known as Lasik, and the other one without a flap - Lasek and Epi-lasik.

PRK
The original laser procedure that Dr. Dello Russo and a handful of surgeons in the nation researched for the FDA was called PRK, where you treat the surface of the cornea directly. The main disadvantage was some pain for 24 hours post surgery and it took several days for vision to return - when the cornea heals enough to a smooth surface again.

Epi-lasik and Lasek
Dr. Dello Russo helped to introduce LASIK in 1997 where the surface of the cornea is lifted in a flap before lasering. With LASIK, vision is restored as soon as the surface is put down. Some doctors who did not adjust to offering LASIK, tried to make a flap of the surface cells (the epithelium) and called it “Epi-lasik” or “Lasek”. Dr. Dello Russo believes that it is not possible to make a flap of the epithelium, but some doctors don’t want to admit that they are actually performing the old procedure (PRK) so they prefer to call it in other names. In effect, they are really treating the surface of the cornea which  is actually the old PRK procedure. There is nothing to be ashamed of, explains Dr. Dello Russo. PRK is a perfectly appropriate replacement for Lasik, when the cornea is too thin.

LASIK
In 1997 an effort was made to conserve the surface of the cornea by lifting it up out of the way of the laser treatment. When the flaps are put down, vision is immediately restored by having original surface available. It is preferable to any form of PRK. Both PRK and Lasik have the same visual results, but it takes a longer time to restore clear vision with PRK, several days instead of overnight with Lasik.

The Post’s article mentions that soldiers sent to Iraq prefer PRK over Lasik. Dr. Dello Russo’s observations:

1. The first soldiers were treated only with PRK. For a while the army would not approve of Lasik, which they now do.
2. PRK costs less to perform and the waiting list is probably shorter.
3. Dr. Dello Russo doubts that the soldiers themselves prefer PRK since they can take off four days instead of two. Soldiers don’t shirk work, says Dr. Dello Russo.