1
|
Poláčková V, Šindelářová H, Lahodová K, Němcová I, Šín M. Refractive Errors Among Members of the Armed Forces of the Czech Republic. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:34-41. [PMID: 38365580 DOI: 10.31348/2024/7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Objective: To evaluate the prevalence of refractive errors among members of the Armed Forces of the Czech Republic, to recommend a safe way of correcting refractive errors with regard to the specific needs of military personnel (especially members of combat units and flying personnel), and to propose a system for solving these errors in order to increase combat effectivity. Methodology: Questionnaire to determine previous refractive surgery and spectacle correction wear. Measurement of refraction with a hand-held autorefractometer and evaluation of current visual acuity on ETDRS optotypes (Landolt rings). Results: 259 servicemen (518 eyes) were investigated. The return rate of the questionnaires was 100%. The incidence of myopia greater than -0.75D was 22% (113 eyes), myopia greater than -0.5D 32% (166 eyes). The mean value of myopia was -0.78 D (SD ±0.6). Hypermetropia values ranged from +0.25 to +5.0 D. The mean value of hypermetropia was 0.63 D (SD ±0.7). Astigmatism values ranged from -0.25 to -3.75. The mean value of astigmatism was -0.55 Dcyl (SD ±0.49). The average visual acuity was 84.1 letters ETDRS SD (±6.1), visual acuity worse than 80 letters was manifested by 23% of the members of the monitored group. 25 people (10%) had undergone laser refractive surgery. Visual acuity after laser refractive surgery was measured in 19 people (38 eyes). Mean uncorrected post-laser visual acuity was 83.87 (SD ±6.1) ETDRS letters. The mean follow-up period after laser refractive surgery was 6.78 (SD ±4.8) years. Conclusion: Despite the initial selection of military personnel and entry limitations, the prevalence of refractive errors is comparable to the general population. However, in contrast with the general population, refractive errors larger than -3.0 D were not represented in the group. Due to the finding of insufficient correction of refractive errors, increased emphasis should be placed on identifying and regularly observing military personnel with refractive errors
Collapse
|
2
|
Greenbaum E, Barayev E, Shpitzer S, Heller D, Nahum Y, Livny E, Gershoni A, Bahar I. Post-refractive surgery of Israeli Defense Forces recruits in 2005-2018-prevalence, combat unit drop-out rates and utilization of eye-care services. Eye (Lond) 2023; 37:1484-1488. [PMID: 35835990 PMCID: PMC10169835 DOI: 10.1038/s41433-022-02164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the number of recruits for military service in the Israeli Defense Force (IDF) who underwent refractive surgery prior to enlistment and examine whether the procedure affected their ability to accomplish combat training. SETTING Medical records of IDF recruits. DESIGN Retrospective analysis of medical records of recruits with ametropia who underwent or did not undergo refractive surgery prior to enlistment. METHODS Recruits were categorized into ametropes and recruits who underwent refractive surgery. Fitness and assignment to combat units and completion status of combat training were compared between the two groups. RESULTS The study included 334,688 (182,969 males, 151,719 females) ametropes of which 5231 (4753 males, 478 females) underwent refractive surgery prior to recruitment. Refractive surgery prevalence increased from 9/1000 ametropes in 2005 to 18.5/1000 ametropes in 2018 (r = 0.912, p < 0.001); 2643 of the operated recruits (50.5%) had their surgery at the age of 17-18. Dropout rates from combat training were significantly lower in the refractive surgery group during the study period (1.68% vs. 6.14%, respectively, p < 0.001). Soldiers in the operated group were more frequently referred to ophthalmologists than those in the ametropes group and less frequently referred to optometrists. CONCLUSIONS The prevalence of refractive surgery in IDF recruits has increased substantially during the last decade with more of them applying to combat units. Refractive surgery opened new possibilities for recruits who were unfit for combat duty prior to surgery and did not appear to impair the chances of successfully completing combat training.
Collapse
Affiliation(s)
- Eran Greenbaum
- Israel Defense Forces, Medical Corps, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Edward Barayev
- Israel Defense Forces, Medical Corps, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Sagi Shpitzer
- Israel Defense Forces, Medical Corps, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Dan Heller
- Israel Defense Forces, Medical Corps, Tel Aviv, Israel
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon, Israel
| | - Yoav Nahum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
| | - Eitan Livny
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel
| | - Assaf Gershoni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Irit Bahar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.
- Assuta Optic Laser Center, Assuta Medical Center, Tel Aviv, Israel.
| |
Collapse
|
3
|
Packer KT, Vlasov A, Greenburg DL, Coggin A, Weightman JW, Beltran T, Berry-Cabán CS, Carroll RB. U.S. military implantable collamer lens surgical outcomes: 11-year retrospective review. J Cataract Refract Surg 2022; 48:649-656. [PMID: 34653095 DOI: 10.1097/j.jcrs.0000000000000818] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the long-term efficacy and safety of myopic implantable collamer lens (ICL) implantation in active duty personnel of U.S. military. SETTING Hospital practice. DESIGN Retrospective longitudinal observational study. METHODS 1485 patients (median age 25, interquartile range 22 to 29) underwent ICL surgery. Patients received a preoperative examination including uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), manifest refraction measuring corrected distance visual acuity (CDVA), corneal topography and tomography, qualitative grading of perceived ectatic risk, ophthalmic biometry, and baseline endothelial cell counts (ECCs). Outcome measures included UDVA, IOP, vault size, manifest refraction, CDVA, and ECCs. The long-term follow-up data ware drawn from the U.S. military medical record system. RESULTS A total of 3105 eyes were evaluated. Patients received ICLs because of either abnormal topography (2111 eyes [68%]) or high myopia (994 eyes [32%]). 94 eyes (80%) maintained UDVA of 20/25 or better up to 8 years postoperatively. The rate of achieving the desired refractive correction was 97% (503 eyes) at 1 year and 90% (81 eyes) at 8 years. Stability of these outcomes was also shown by minimal change in manifest refraction. Documented mean ECC loss was 22% at postoperative year 5. The overall rate of adverse events was 1.2% (36 eyes) including visually significant cataract formation, glaucoma, retinal detachment, and traumatic incision opening. A removal or replacement rate of 4.5% (135 eyes) was observed. CONCLUSIONS ICL implantation was found to be effective and safe. Vault sizes decreased over time, suggesting an increased risk of cataract formation after 7 years. Further study is necessary to assess long-term clinical significance of ECC decline.
Collapse
Affiliation(s)
- Kyle T Packer
- From the Department of Ophthalmology, Womack Army Medical Center, Fort Bragg, North Carolina (Packer, Vlasov, Greenburg, Coggin, Weightman, Carroll); Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina (Beltran, Berry-Cabán)
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Branger GA, Le MT, Inauen LO, Reichmuth V, Kaufmann C, Baenninger P. Ten-Year Outcome of Topography-Guided Transepithelial Surface Ablation for Refractive Myopia Treatment. Klin Monbl Augenheilkd 2022; 239:382-385. [PMID: 35320865 DOI: 10.1055/a-1739-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To evaluate 10-year long-term refractive visual stability and participants' satisfaction in the refractive treatment of myopic eyes undergoing topography-guided transepithelial surface ablation using a 1KHz excimer laser. PATIENTS AND METHODS This single-center prospective survey assessed participants' satisfaction 10 years after the treatment using a non-validated questionnaire with regards to visual outcome, dry eye, and visual disturbance symptoms. Pre- and postoperative visual and refractive data were evaluated. RESULTS Of 106 participants (54% females) with a mean patient age of 36 (± 8.6) years, 166 eyes were included. Mean preoperative spherical equivalent (SE) was - 4.23 (± 2.48) diopters (D). Uncorrected distant visual acuity (UCVA) after 10 years was ≥ 1.0 (Snellen) in 92% of the eyes. Manifest SE was within ± 1.0 D of the desired refraction in 86% of the eyes after 10 years. Mean quality of life (QOL) improvement was high (9.15 out of 10 points). Dry eye symptoms were reported by 35 out of 104 (34%) patients. Visual symptoms like halos or starbursts were reported by 24 out of 101 (24%) and 12 out of 100 (12%) patients, respectively. CONCLUSIONS Topography-guided transepithelial surface ablation for myopia provided stable long-term results in terms of UCVA and SE. Participant satisfaction was high, with only low rates of dry eye or visual symptoms.
Collapse
Affiliation(s)
| | - Minh Tu Le
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland
| | | | | | - Claude Kaufmann
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.,Faculty of Medicine, University of Zurich Faculty of Medicine, Zurich, Switzerland
| | - Philipp Baenninger
- Augenklinik, Luzerner Kantonsspital, Luzern, Switzerland.,Faculty of Medicine, University of Zurich Faculty of Medicine, Zurich, Switzerland
| |
Collapse
|
5
|
Philbrick SM, Bennion JL. Intra-Operative Discomfort in Photorefractive Keratectomy. Clin Ophthalmol 2021; 15:4121-4130. [PMID: 34675479 PMCID: PMC8520965 DOI: 10.2147/opth.s327057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Photorefractive keratectomy (PRK) remains a viable, safe, and efficacious option for patients wishing to correct refractive errors. One of its most significant drawbacks is pain. While post-operative pain has been well studied with different management options, intra-operative pain has been less well defined. The purpose of this study was to characterize intra-operative pain during PRK in regard to eye operated on, gender, excimer platform used, surgeon, and age. Patients and Methods A total of 134 patients (264 eyes) were prospectively randomized to undergo bilateral PRK of either the right eye first or the left eye first followed immediately by the fellow eye. In the immediate post-operative period they were surveyed using an 11-point Numeric Rating Scale regarding intra-operative pain or discomfort experienced in each eye. Resultant pain scores were then analyzed via two sample z-test and analysis of variance (ANOVA) to characterize pain overall as well as comparing first versus second eye operated on, right versus left eye, male versus female, excimer platform used, inter-surgeon variability, and age. Results Of 264 eyes surveyed the mean pain experienced on a 0–10 pain scale was 1.13 (minimal discomfort). There was no statistically significant difference in pain or discomfort when comparing first versus second eye operated on, right versus left eye, male versus female, excimer platform used, operating surgeon, or age. Conclusion Intra-operative pain or discomfort experienced by patients is minimal. The absence of statistically significant differences in pain scores studied implies that standard of care procedures achieve adequate analgesia in PRK.
Collapse
Affiliation(s)
- Samuel M Philbrick
- Department of Operational and Readiness Medicine, Joint Base Elmendorf-Richardson Hospital, Elmendorf, AK, USA
| | - John L Bennion
- Department of Ophthalmology, Saint Alphonsus Health System, Boise, ID, USA
| |
Collapse
|
6
|
Longitudinal Changes in Optical Quality, Spatial Vision, and Depth Vision after Laser Refractive Surgery for Myopia. Optom Vis Sci 2021; 97:360-369. [PMID: 32413008 DOI: 10.1097/opx.0000000000001513] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Laser refractive surgery procedures are efficacious at correcting myopia, but they result in long-term deterioration of optical quality that affects monocular and binocular visual performance. The study shows that the optical quality of the two eyes needs to be similar to optimize binocular visual performance after surgery. PURPOSE This study aimed to systematically analyze longitudinal changes in optical quality, high- and low-contrast logMAR acuity and random-dot stereoacuity before and after three refractive surgery procedures for correcting myopia. METHODS A total of 106 subjects (laser-assisted in situ keratomileusis, 40; photorefractive keratectomy, 26; small-incision lenticule extraction, 40) with myopia and astigmatism ≤1.5 D participated in this prospective cohort-based study. All aforementioned outcome variables were measured in both eyes pre-operatively and 1 week and 1, 3, and 6 months post-operatively. RESULTS Pre-operative myopic spherical equivalent of refraction (median [25th to 75th interquartile range], -6.4 D [-8.0 to -4.2 D] for laser-assisted in situ keratomileusis, -4.3 D [-5.0 to -3.5 D] for photorefractive keratectomy, -5.5 D [-6.5 to -4.3 D] for small-incision lenticule extraction) was corrected to within ±0.75 D of emmetropia in all cohorts up to 6 months post-operatively (P < .001). Higher-order wavefront aberrations, uncorrected high- and low-contrast logMAR acuity, and stereoacuity all worsened and remained so up to 6 months post-operatively, relative to pre-operative values (P < .001). Stereoacuity worsened with both interocular average and difference in the magnitude of higher-order aberrations, whereas logMAR acuities worsened only with interocular average of these aberrations (r ≥ 0.40; P < .01 for all). CONCLUSIONS Although the refractive surgery procedures tested here correct myopia, they result in a sustained (up to 6 months) loss of optical quality and spatial and depth-related visual functions post-operatively. Both interocular average and difference in the eye's optical quality seem to impair binocular visual functions after refractive surgery for myopia.
Collapse
|
7
|
Visual outcomes after SMILE from the first-year experience at a U.S. military refractive surgery center and comparison with PRK and LASIK outcomes. J Cataract Refract Surg 2020; 46:995-1002. [PMID: 32271272 DOI: 10.1097/j.jcrs.0000000000000203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the visual outcomes of small-incision lenticule extraction (SMILE) after the first year of treatments at a military refractive surgery center and compare with photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) outcomes during the same period. SETTING Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA. DESIGN Retrospective study. METHODS Records of service members who underwent SMILE, PRK, or LASIK for myopia from March 2017 to February 2018 were reviewed. Preoperative and up to 6-month postoperative data were collected. Visual outcomes were compared between treatments. RESULTS Of 563 treated eyes, 173 (30.7%) underwent SMILE, 304 (54.0%) PRK, and 86 (15.3%) LASIK. In comparing SMILE with PRK 1 month postoperatively, SMILE (145 eyes [87.9%]) attained uncorrected distance visual acuity (UDVA) ≥20/20 more vs PRK (214 eyes [73.8%]; P < .01). Similarly, SMILE (152 eyes [94.4%]) achieved more eyes with manifest spherical equivalent (MSE) within ±0.50 diopters (D) from intended target vs PRK (250 eyes [85.9%]; P = .01). None lost ≥1 line of corrected distance visual acuity in SMILE vs PRK (16 eyes [5.5%]; P < .01). Thereafter, there were no other significant differences except SMILE had 117 eyes (95.1%) vs PRK with 224 eyes (99.6%) achieving UDVA ≥20/20 at 3 months postoperatively (P = .01). In assessing SMILE vs LASIK, all parameters were comparable; however, 77 SMILE eyes (96.3%) had MSE within ±0.50 D from target vs 31 LASIK eyes (83.8%) at 6 months postoperatively (P = .02). CONCLUSIONS The first year after SMILE treatments in a U.S. military center demonstrated early postoperative outcomes superior to PRK. SMILE seemed more predictable compared with LASIK.
Collapse
|
8
|
Biscevic A, Bohac M, Pjano MA, Grisevic S, Patel S, Pidro A. Treatment of High Astigmatism with WaveLight Allegretto Eye-Q Excimer Laser Platform. Acta Inform Med 2019; 27:177-180. [PMID: 31762574 PMCID: PMC6853724 DOI: 10.5455/aim.2019.27.177-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction The WaveLight Allegretto Eye-Q is a flying-spot excimer laser, with a pulse repetition rate of 400Hz, with two galvanometric scanners for positioning laser pulses. The system has an infrared high speed camera operating at 400Hz to track the patient's eye movements that either compensates for changes in eye position or interrupts the treatment if the eye moves outside a preset predetermined range. Aim The purpose of this study was to investigate WaveLight Allegretto Eye-Q 400Hz laser delivery platform aimed to correct astigmatism by subjecting the pre and postoperative astigmatic values to vector analysis. Methods Patients were divided into two groups, depending on the type of astigmatism. Astigmatism was between 2 and 7 diopters (D). A total of 188 eyes (110 patients), 127 eyes (71 patients) with myopic astigmatism and 61 eyes (39 patients) with mixed astigmatism underwent unremarkable LASIK correction on WaveLight Allegretto Eye-Q 400Hz. The preoperative and postoperative sphere, negative cylinder [C] and axis (ø) of manifest refractions were subjected to vector analysis by calculations of the standard J0 (cos [4π(ø-90)/360]xC/2) and J45 (sin[4π(ø-90)/ 360]xC/2). Results Reporting the key results, we found that J0 significantly reduced after LASIK (p<0.001) but not J45. There was no significant association between individual pairs of pre and postoperative J0 &J45 values. Conclusion WaveLight Allegretto 400Hz showed excellent results for treating patients with high astigmatism, regardless whether it is mixed or myopic astigmatism. The J45 did not reduce significantly possibly because of the low number of eyes with oblique astigmatism. There was no genuine difference postoperatively between groups treated on WaveLight Allegretto platform according to the vector analyses.
Collapse
Affiliation(s)
- Alma Biscevic
- Eye Clinic Svjetlost Sarajevo, Sarajevo, Bosnia and Herzegovina.,University Eye Clinic Svjetlost Zagreb, Zagreb, Croatia
| | - Maja Bohac
- University Eye Clinic Svjetlost Zagreb, Zagreb, Croatia
| | | | - Senad Grisevic
- Eye Clinic Svjetlost Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sudi Patel
- NHS National Services Scotland, Edinburgh, United Kingdom
| | - Ajla Pidro
- Eye Clinic Svjetlost Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|