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Military Health System

MHS refractive surgery experts discuss warfighter readiness

Image of Mr. McCaffery looking at a monitor with an eye on it. Click to open a larger version of the image. Assistant Secretary of Defense for Health Affairs Thomas McCaffery observes the beginning stages of a refractive surgery at the Warfighter Refractive Surgery Center at Joint Base San Antonio-Lackland, Oct. 21. The center is the largest refractive training program in the Department of Defense and has trained and certified more than 150 refractive surgeons. (Photo by Air Force Staff Sgt. Amanda Stanford, 59th Medical Wing.)

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More than 200 participants from around the military ophthalmology and optometry communities gathered virtually on Jan. 8 to share ideas for the first time since the beginning of the transition to the Defense Health Agency.

The group participated in the “Refractive Surgery – Excellence for the Warfighter” virtual meeting where they discussed the latest techniques, safety protocols, and standards for refractive surgery. The meeting provided an opportunity for colleagues to share their experiences and get advice from experts, and was held in place of the annual Military Surgery Safety and Standards Symposium.

“We’ve been meeting since 2007 to talk about our best practices, our standards, lessons learned and safety,” said Army Maj. (Dr.) Gary Legault, Army Refractive Surgery Program manager and refractive surgery consultant to the Army surgeon general. “We emphasize key safety issues with the laser platforms and with our treatments and share the latest and greatest technology and updates.”

Refractive surgery is any surgery that eliminates the need for glasses or contact lenses. Refractive surgeries include LASIK (laser-assisted in situ keratomileusis), PRK (photorefractive keratectomy), ICLs (implantable contact lenses), and SMILE (small incision lenticule extraction).

Within the Military Health System, these procedures are designed to improve the functionality, lethality, and combat readiness of the warfighter through improving their visual system. Refractive surgery is offered at no cost to qualifying service members with conditions including nearsightedness, farsightedness, and astigmatism.

Legault explained that his hope was for the meeting to produce practical lessons that those in attendance could use on a regular basis.

“We hope this helps the people in attendance from around the world of military ophthalmology and refractive surgery learn something new that they can apply to improving their practice with their patients,” Legault said.

Among the positive outcomes from the MHS’s transition to the DHA is a tri-service effort to standardize refractive surgery across the DOD.

“For us, it’s a benefit as the DHA helps us improve our standardization and create a standard experience across the board as well as become more efficient,” Legault said. “I think the DHA can help us improve our outcomes by sharing best practices and working together as a group.”

Navy Lt. Cmdr. (Dr.) Tyler Miles, research director and division officer for Naval Medical Center San Diego’s Refractive Surgery Center, agreed.

“This is an opportunity for us to all come together and share what we’re doing. We have different flavors amongst the different services, and it’s nice to be able to share our gains across the board,” Miles said.

Paramount among the improvements resulting from the transition, is having a refractive surgery board at the DHA level, he explained.

“We now have a formal voice at that tri-service level, so that might bring some formal processes that empower our programs more than before,” Miles said.

As with many other areas of military medicine, COVID-related impacts to refractive surgery include a shift to a more virtual-heavy way of conducting consultations and pre-surgery briefs.

Legault said that the most important aspect what they do is improving combat readiness.

“We want to improve the warfighter in order for them to be better at their occupation, and we want commanders and leaders to know that we are here to help,” he said. “We’re here to assist.

“It can literally mean life and death where you can see your enemy through improved visual function versus your glasses fogging up or falling off,” Legault said. “These are procedures that can make a huge difference and occur within minutes.”

Miles agreed, saying, “This is one of the few instances where we’re actually enhancing the warfighter. We’re not just fixing them up and keeping them healthy, we’re making them better. We’re providing an enhancement by making them less reliant on glasses and contact lenses, which, although they’re effective in giving you clearer vision, may be a liability in certain areas where our folks are operating.”

Proof for him that their programs are headed in the right direction, he said, is in the outcomes he’s seen.

“You just have to spend a day in a clinic seeing post-operative patients,” Miles said. “They’ll tell you that it is life-changing to be able to wake up in the morning and open their eyes and see clearly, aside from the performance advantage that it’s giving our military.”

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