Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

Corneal Collagen Cross Linking in the Military a Game Changer

Image of Corneal collagen cross-linking, known as CXL, the first and only treatment to date that is proven to stop Keratoconus, KCN, progression. Corneal collagen cross-linking, known as CXL, the first and only treatment to date that is proven to stop Keratoconus, KCN, progression.

For years, Keratoconus has been a disqualifying condition in the military, and a reason why refractive surgery is often denied to service members.

Keratoconus (pronounced Keh·ruh·tow·kow·nuhs), or KCN, is an eye condition where the front part of the eye (cornea) gradually thins out and bulges causing irregularity and blurred vision.

KCN may result from eye rubbing. It has also been linked to sleep apnea, asthma, allergy, eczema, vernal conjunctivitis, floppy eyelid syndrome, connective tissue disorders, or a family history of KCN. Historically, the primary treatment for KCN was contact lenses when eyeglasses were not sufficient to correct the irregular astigmatism. Severe cases were treated with corneal transplantation.

Navy Capt. (Dr.) John Cason, prior ophthalmology specialty leader and refractive surgery advisor, stated that, he reviewed about 2 to 5 sailor applicants per month for possible waiver for accession into the military due to KCN.

In 2016, the Food and Drug Administration approved corneal collagen cross-linking, known as CXL. This is the first and only treatment proven to stop KCN progression.

Air Force Col. (Dr.) Matthew Caldwell, ophthalmology consultant to the Air Force Surgeon General, called CXL a "readiness game changer." He noted that "KCN is of special interest to the military as the age range of impact nearly exactly overlaps years of active-duty service." The onset can happen before or after acceptance into the military when screening is too late.

"KCN impacts the ability to deploy and can degrade vision excluding careers in aviation, Special Forces, and in severe cases, even less visually intensive administrative work," added Caldwell.

Since the FDA approval, hundreds of service members have been treated with CXL. And a majority of these have been able to retain their military careers.

Air Force Col. (Dr.) Joseph Giovannini, cornea specialist at the David-Grant USAF Medical Center at Travis Air Force Base in California stated, "I have seen several military careers saved by the procedure."

Air Force Capt. Lowell DePalma, an aviator who had bilateral CXL, backed up Giovannini, "CXL has allowed me to keep my job and helped my future eye exams to be more predictable."

Currently, ophthalmology consultants are able to recommend acceptance waivers for military candidates with early KCN as long as they are able to show stability after CXL procedure.

"CXL has offered the possibility of military service for a group of candidates with mild symptoms from KCN," stated Cason. In the past, these volunteers didn't have the option of continued service due to restrictive guidelines that did not offer any flexibility with treatment. CXL has given these people the possibility of treatment, stability, and a future military service that were previously denied."

In the future, CXL may also significantly expand the options of vision-enhancing refractive surgery. In the past, service members with abnormal corneal scans were disqualified from refractive surgery. However, over the past decade, CXL plus refractive surgery outcomes have been favorable.

"The advent of CXL has helped tremendously to retain highly trained individuals and increase the applicant pool for the armed services," explained Air Force Lt. Col. (Dr.) James Townley, refractive surgery consultant to the Surgeon General of the Air Force.

As technology continues to advance, the use of CXL and refractive surgery will help more service members remain on active duty.

All authored materials constitute the personal statements of the names listed above and are not intended to constitute an endorsement by the Unites States Air Force or any other Federal Government entity

You also may be interested in...

Report
Jan 1, 2018

MSMR Vol. 25 No. 11 - Nov 2018

.PDF | 1.06 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Contributions from the Global Emerging Infections Surveillance (GEIS) network; Brief report: Pre- and post-deployment prevalence of Staphylococcus aureus colonization among U.S. Navy submariners; Surveillance ...

Report
Jan 1, 2018

MSMR Vol. 25 No. 1 - January 2018

.PDF | 784.31 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Review of the U.S. military's human immunodeficiency virus program: a legacy of progress and a future of promise; Update: Routine screening for antibodies to human immunodeficiency virus, civilian applicants ...

Report
Jan 1, 2018

MSMR Vol. 25 No. 2 - February 2018

.PDF | 985.98 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Update: Malaria, U.S. Armed Forces, 2017; Surveillance for vector-borne diseases among active and reserve component service members, U.S. Armed Forces, 2010–2016; Diagnostic evaluation of military blood donors ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 12 - December 2017

.PDF | 1.45 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Insomnia and motor vehicle accident–related injuries, active component, U.S. Armed Forces, 2007–2016; Seizures among active component service members, U.S. Armed Forces, 2007–2016; Brief report: Prevalence of ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 10 - October 2017

.PDF | 1.16 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Measles, mumps, rubella, and varicella among service members and other beneficiaries of the Military Health System, 2010-2016; Update: Cold weather injuries, active and reserve components, U.S. Armed Forces, ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 1 - January 2017

.PDF | 998.69 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Update: Malaria, U.S. Armed Forces, 2016; Diabetes mellitus, active component, U.S. Armed Forces, 2008–2015 introduction of the virus in the Western Hemisphere, 1 January 2016; Rates of Chlamydia trachomatis ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 6 - June 2017

.PDF | 1.12 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Incidence of Campylobacter intestinal infections, active component, U.S. Armed Forces, 2007–2016; Incidence of nontyphoidal Salmonella intestinal infections, active component, U.S. Armed Forces, 2007–2016; ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 7 - July 2017

.PDF | 1.18 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Skin and soft tissue infections, active component, U.S. Armed Forces, 2013–2016; Age-period-cohort analysis of colorectal cancer, service members aged 20–59 years, active component, U.S. Armed Forces, 1997–2016 ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 11 - November 2017

.PDF | 1.52 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Pregnancies and live births, active component service women, U.S. Armed Forces, 2012–2016; Contraception among active component service women, U.S. Armed Forces, 2012–2016; Complications and care related to ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 9 - September 2017

.PDF | 1.03 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Review of the U.S. military's human immunodeficiency virus program: a legacy of progress and a future of promise; Update: Routine screening for antibodies to human immunodeficiency virus, civilian applicants ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 2 - February 2017

.PDF | 1.31 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Incident diagnoses of leishmaniasis, active and reserve components, U.S. Armed Forces, 2001–2016; Incidence rates of malignant melanoma in relation to years of military service, overall and in selected ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 8 - August 2017

.PDF | 986.46 KB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Multiple sclerosis among service members of the active and reserve components of the U.S. Armed Forces and among other beneficiaries of the Military Health System, 2007–2016; Challenges with diagnosing and ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 4 - April 2017

.PDF | 1.29 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Absolute and relative morbidity burdens attributable to various illnesses and injuries, active component, U.S. Armed Forces, 2016; Hospitalizations, active component, U.S. Armed Forces, 2016; Ambulatory visits, ...

Report
Jan 1, 2017

MSMR Vol. 24 No. 3 - March 2017

.PDF | 1.60 MB

A monthly publication of the Armed Forces Health Surveillance Branch. This issue of the peer-reviewed journal contains the following articles: Diagnoses of traumatic brain injury not clearly associated with deployment, active component, U.S. Armed Forces, 2001–2016; Update: Heat illness, active component, U.S. Armed Forces, 2016; Update: Exertional ...

Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery