New Refractive Surgery Procedures and Their Implications for Aviation Safety

Since the early 1980s, civil airmen have been allowed to correct refractive error (i.e., myopia, hyperopia, astigmatism) with corrective surgery. Prior Federal Aviation Administration research studies have shown that the number of civil airmen with refractive surgery continues to increase. A study that reviewed refractive surgery use in civil airmen for the years 1994-96, reported that the largest percentage had radial keratotomy (RK). A similar study that reported on the years 1996-2001, however, showed that there had been a substantial increase in the percentage of airmen with laser refractive surgery, i.e., photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). A reference guide on refractive surgery was published in September of 1998 (DOT/FAA/AM-98/25); however, at that time long-term clinical data on PRK and LASIK were not available. The introduction of new refractive surgical techniques (e.g., laser epithelial keratomileusis [LASEK], laser thermal keratoplasty [LTK], conductive keratoplasty [CK], Intacs™, phakic IOLs, and presbyopia surgeries) and technology (e.g., wavefront-guided systems, Femtosecond Lasers, inlays, and onlays) has further added to concerns regarding the use of refractive surgical procedures by aviators. In order to provide the aviation community with information to formulate administrative decisions and policies associated with existing and emerging refractive surgical procedures, this paper reviews current procedures and discusses their applicability in the civil aviation environment.