Wright-Patterson Medical Center Laser Surgery Center: Giving Clear Vision to the Warfighter

Published April 8, 2008
By Mike Frangipane
88th Air Base Wing Public Affairs

WRIGHT-PATTERSON AIR FORCE BASE, Ohio -- Late in 2000 JoAnn Stewart, retired Air Force Ophthalmology Technician, received a phone call. At the other end was the familiar voice of Dr. (Col.) Leo Hurley, OD, MD at Wright-Patterson Medical Center. They had served together some 20 years before on Hurley's first assignment and again more recently on Mrs. Stewart's last assignment here at Wright-Patterson before retirement.

Dr. Hurley explained the reason for his call. The Department of Defense had issued a directive establishing warfighter laser surgery centers and he had been charged to stand up a center at Wright-Patterson Medical Center. He needed help and the first call he made was to Mrs. Stewart. "I said, 'Jo can you do it.' She had all this expertise. She knew how to put contracts together, she knew how to buy supplies, all the stuff I didn't know," explains Dr. Hurley. She was the first person he turned to for help and she said "Yes."

With Mrs. Stewart contributing the administrative expertise, Dr. Hurley the professional medical skills, and armed with a $2.2 million budget, they embarked upon what both now described as "an amazing experience." The face of the floor space allotted to the new laser center was completely transformed. Everything had to be torn out and replaced. We had to buy all the equipment, hire the people. All of the administrative procedures, down to application forms, had to be designed. "It was like building a practice," said Dr. Hurley. In the process they put together a well oiled, professional and very successful laser surgery center with a dedicated and skilled staff, many of whom are still with the center.

The staff they assembled is committed to delivering the highest quality of care to the warfighter. Dr. Hurley, now Chief of Ophthalmology and Refractive Surgery, describes their task in terms of increasing the readiness of the force. He pointed to a picture on the wall of the center of several young troops sitting on a bench. Each is armed with a weapon, but one of the troops near the center of the frame stands out from the rest. He alone among his comrades is wearing traditional military issue eyeglasses. Pointing to that troop, Dr. Hurley explains, "That fellow is what we are all about. If we can take him out of his glasses and his dependence upon them ... and we are very good at that ... we can make him more effective. The possibility of his loosing or breaking his glasses in an extreme situation will no longer be an issue impacting the readiness of this warfighter."

Dr. Hurley's colleague, Dr. (Maj.) Patrick Kelly, Opthalmology/Refractive Surgery, adds, "We are using cutting edge technologies to give the warfighter the best opportunities available."

The Wright-Patterson center, one of five Air Force wide, opened its doors in 2001 and has served more than 9000 active duty patients freeing them from dependence upon glasses or contact lenses. Patients come to the Wright-Patterson Center from all of the U.S. military services. Approximately 80% of the center's patients are from out of town. "People fly in from all over the country," said Dr. Hurley. Accommodations for those coming from a distance are provided on base at the Fisher House, within walking distance of the Medical Center.

The center initially offered Photo Refractive Keratectomy (PRK) alone. It now offers Laser-Assisted In Situ (in its place) Keratomileusis (LASIK) and Epi-LASIK as well.

Laser surgery corrects myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (distortion of the image on the retina). A screening process will determine whether a patient is a candidate for surgery and which procedure, PRK or LASIK, best suits him. The entire process begins with a patient assessment and referral to the center by a DoD optometrist or ophthalmologist. Screening also includes signed approval by the individual's commander, supervisor and mobility officer. Aviators, navigators, and special duty personnel have the additional requirement of submitting their application to Brooks AFB, Texas, for approval.

Active duty individuals interested in pursuing freedom from their eyeglasses or contact lenses are invited to attend the regularly offered briefing by Dr. Hurley in which he describes the screening process and the PRK and LASIK procedures in detail. The briefing includes an opportunity for questions to be answered. This free briefing is held the first and third Tuesday of every month from 1-2 PM at the hospital auditorium (Bldg 830, Room BNN1). No appointment is required.

"When you think of it," concludes Dr. Hurley, "next to living, we all value our sight. If we can make someone see better, which we do all the time, you make a lot of friends. That is why this is a very rewarding job."

Corneal Refractive Surgery: PRK verse LASIK corrective eye surgery

Corneal Refractive Surgery or Laser Eye Surgery is performed on active duty military personnel at Wright-Patterson Medical Center Warfighter Laser Surgery Center, one of five Air Force centers.

Laser surgery eliminates the need for prescription eyeglasses and contact lenses by using the laser to mold or sculpt the cornea, the clear front opening of the eye, into a lens-like structure that will focus light more accurately upon the retina. The exacting precision of the computer controlled laser makes it possible to change the shape of the cornea so that it can accomplish more precisely the focusing task of the curved lens of an eyeglass or contact lens. There are essentially two kinds of laser eye surgeries. Both utilize a computer controlled excimer laser. Each procedure differs only in the means by which the surgeon gains access to the layer of the cornea upon which the laser will do its lens sculpting work.

The first of those procedures is Photo Refractive Keratectomy (PRK) which completely removes the outer layer of the cornea exposing the inner corneal layer to the surgeon's laser for shaping into a lens. Computer programs guide the laser in its work insuring precise sculpting of the corneal tissue. The removed outer layer of the cornea will in a short time grow back as a clear covering to the reshaped layer.

The second procedure is Laser-Assisted In Situ (in its place) Keratomileusis (LASIK). The LASIK procedure temporarily removes the outer layer of the cornea by a circular cut flap. A portion of the circular flap is left uncut to serve as a hinge by which the flap can be pealed back to reveal the inner corneal layer. When the laser sculpting work is complete, the flap is laid back in place to heal.

Both methods are available at the Wright-Patterson Laser Surgery Center. PRK was the earliest method developed. It initially had the drawback of being somewhat more painful during the healing process and there was concern about scarring of the outer corneal tissue as it grew back. There was also the matter of a longer period of recovery, running from weeks to months for some patients. While the healing time remains longer, the issues of pain and scarring have now been resolved. A medication is now used to prevent scarring and effective pain management techniques have reduced the pain experienced by PRK patients to an average level 2 on a scale of 1-10 (1 the least and 10 the greatest pain).

LASIK was developed as a response to the pain issue of PRK and is primarily in use in the civilian sphere. After studies revealed that the early concerns about the stability of the flap created by this procedure were unfounded, LASIK became available at Air Force Centers. Its lower pain and more speedy recovery (days to weeks) have made it a popular alternative to PRK.

Despite the development of LASIK, however, PRK remains first in the number of refractive surgeries performed in Air Force centers. "If you take a modern laser such as we now have and do the same prescription for LASIK and for PRK and allow them both to the heal sufficiently (PRK will take a little longer healing time), the PRK eye will have a better quality of vision," explains Dr. (Col.) Leo D. Hurley, OD, MD, Chief Ophthalmology and Refractive Surgery; Commander, Surgical Specialties Flight. "I still love LASIK. It's a great procedure, but I am an even bigger fan of PRK," said Dr. Hurley.

Warfighter Laser Surgery Center: Testimony of a satisfied customer

The news service editor at the 88 ABW Public Affairs office received laser corrective eye surgery Jan. 30 at the Wright-Patterson Warfighter Laser Surgery Center.

When asked why she wanted to have it done 1st Lt. Holly R. Layer said simply, "I wanted to see the alarm clock in the morning."

It is an answer that fits with the goal of the center to free the warfighter of his/her dependence on glasses, to increase the readiness of the individual to do the task given without having to search for eyeglasses or be concerned that a jolt or mishap may break them and cause some measure of visual incapacity.

Lt. Layer said the thought of obtaining this freedom sounded like a "great opportunity." This was verified by several fellow Airmen.

"I've known multiple people who have had the surgery and every one has been more than impressed.," she said, "I figured the benefits outweighed the risks and I thought I'd give it a chance."

Lt. Layer received photorefractive keratectomy or PRK. When asked about her experience undergoing the procedure, she responded, "It was great! For the most part it was wonderful. The customer service at the Warfighter Laser Surgery Center is excellent. They were always available to answer questions and they really take care of you."

She said the staff is great. "I really want to plug that," Lt. Layer said. "They are wonderful. It has just been an easy process."

Lt. Layer's ophthalmologist on base referred her for surgery, suggesting that she was a good candidate. She attended the information session offered on the third Tuesday of the month and received all the information. She filled out the forms and was then put on a waiting list. In six weeks she had her screening appointment and in another six weeks was scheduled for the surgery. According to Warfighter Laser Surgery Center officials, these waiting periods will vary according to the volume of patients. Lt. Layer said she found the process of getting to the surgery a relatively short and encouraging one.

"They really prepare you for what you are going to do" she said. "They take all the tests. You are very confident that everything is going to go well, and they give you this huge briefing the day before. You show up the morning of and you're good to go. It takes less than a minute in each eye and then you go home."

Describing her surgical experience, Lt. Layer said, "They give you a sedative, the smallest dose you can get. ... They have a little clamp to hold your eye open. It is not painful, but can be a little uncomfortable. They start with one eye and basically it is a machine that does all the work. ... They walk you through it so you know what to expect.

"The first part, which takes probably less than a minute, is when they take off the epithelium, the top layer of the cornea. You can't feel that at all. It is done with the laser. ... You then focus on the red light for about 45 seconds (as the laser works on the inner layer of the cornea). The light gets blurred because they are fixing your eye. You focus on the (red light), and they count it down. They said they have had a couple that take a little longer. It depends on the amount of correction needed. They finish by washing the eye with saline solution, the most uncomfortable part of the procedure. Then they do the other eye and you get up and you can read the clock across the room."

When asked about the pain she felt following the surgery Lt. Layer said, "I had virtually no pain recovery wise. I had a little discomfort. You go home that first day and you are very sensitive to light (According to Warfighter Laser Surgery Center officials, patients must faithfully wear sunglasses outdoors for a year following the surgery.). I slept a bit, but I was up and at 'em that night. We had the lights dimmed but I was watching TV with the family, eating and slept through the night pretty well.

"I wore the bandage contacts they gave me for six days, protective lenses. The key to pain management is not waiting until the pain comes before dealing with it. Avoid the pain by staying ahead of it with the medication. I had someone there to make sure I was taking the painkillers on time. It worked just fine. I had a little discomfort, a little light sensitivity, but by week's end it was fine. My vision was a little fuzzy for maybe two weeks."
Eight weeks post-op, Lt. Layer said she is still doing "the taper drops," reducing the dosage on a prearranged schedule, and using drops to make sure her eyes aren't healing too fast and are going to scar.

"They encourage you to use artificial tears as often as you want to keep the eyes moistened, but other than that, I am completely back to normal," said Lt. Layer.

When asked if she would recommend the surgery, Lt. Layer said, "I highly recommend it. If you are a candidate, go for it."

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Wright-Patterson Medical Center Laser Surgery Center: Giving Clear Vision to the Warfighter