Refractive Surgery Program Flashcards

1
Q

Define the role of the FS in the refractive surgery program.

A

Pre-op: Application, pre-surgical criteria

Post-op: DNIF, RTFS and waiver

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2
Q

How much of refraction power is from the cornea?

A

2/3

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3
Q

Describe where the image is focused in myopia, hyperopia and astigmatism.

A
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4
Q

What is done to the cornea during refractive surgery in myopia, hyperopia, and astigmatism?

A
  • Myopia– central cornea flattened
  • Hyperopia– peripheral cornea flattened
  • Astigmatism– asymetric treatment
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5
Q

List the types of refractive surgery and give examples. What is PRK and LASIK classified as? Why do you need to know these?

A
  • ASA (advanced surfce ablation)– PRK, Epi-LASIK, LASEK
  • ISA (Intra-stromal ablation)– LASIK

Must know these as these are the only procedures approved for aircrew.

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6
Q

Discuss refractive effect on presbyopia, particularly in relation to mild/moderate myopia.

A

CRS will not correct presbyopia.

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7
Q

List 3 complications of CRS and their management.

A
  1. Corneal haze– steroid drops and re-scrape epithelium
  2. Striae ad microstriae
  3. Flap dislocation (LASIK)
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8
Q

Discuss altiude effects with PRK and LASIK.

A
  • PRK– none
  • LASIK– change in visual acuity reported in climbers
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9
Q

How long are steroid eye drops required post-CRS? Why does this matter aeromedically?

A
  • PRK– 2-4 months
  • LASIK– 1 week

Required to be DNIF while on steroid eye drops. However, must be minimum of 1 month, even though off steroid drops earlier with LASIK.

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10
Q

List 9 pre-surgical requirements for CRS.

A
  1. > 6 months retainability
  2. > age 21
  3. Rx stability (< 0.50 diopter change over 1 yr)
  4. Normal corneal topography (no kerataconus)
  5. Adequate corneal thickness
  6. Discontinue contacts
    1. SCL– 1 month prior (14 days for non-aircrew)
    2. Hard– 90 days
  7. Contraindicated ophtho & systemic comorbidities
  8. Not on contraindicated meds
  9. 6-months post-pardum and not breastfeeding
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11
Q

List refraction limits for CRS in myopia, hyperopia and astigmatism

A
  • Myopia: -8.00
  • Hyperopia: +3.00
  • Astigmatism: 3.00

Must ensure that conversion calculations done

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12
Q

What must aircrew have prior to CRS regardless of where the surgery is done?

A

Permission to Proceed

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13
Q

When can aircrew RTFS?

A

Following MAJCOM waiver

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14
Q

List 6 required exam items required for RTFS waiver.

A
  1. 20/20 on OVT
  2. 20/50 on Precision Vision 5% chart
  3. OVT-DP
  4. Refraction
  5. Rx stability
  6. Normal exam (slit lamp, DFE, IOP)
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15
Q
A
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16
Q

What is the median RTFS time for PRK and LASIK? Why does this matter in AFSOC?

A

50% RTFS

  • PRK @ 4 mo
  • LASIK @ 3 mo

AFSOC deployment cycles are 90 days, therefore only approving LASIK

17
Q

Why is there concern about CRS at altiude?

A

Cornea is avascular. Gets oxygen from atmosphere.

18
Q

What causes the perceived halo following CRS?

A

The area of ablation is the area of good refraction. Light that comes in at edge is perceived as a halo. Incidence has decreased with increasing area of ablation zone.

19
Q
A