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Refractive Surgery In the Military
LTC Jeff Rabin, OD, PhD
Center for Refractive Surgery
Walter Reed Health Care System
Washington, DC
In the past we had…
Radial Keratotomy (RK)
Deep spoke-like
incisions
Central cornea
flattens
For mild to
moderate myopia
Good results
Weakens cornea
Now we have…
Laser Procedures
• PRK
• LASIK
Photorefractive Keratectomy
(PRK)
Excimer laser
reshapes cornea
Very precise
For myopia,
hyperopia,
astigmatism
Good results &
safety
LASIK
Microkeratome
flap
Excimer laser
removes precise
amount corneal
tissue
For myopia,
astigmatism and
hyperopia
Rapid popularity
worldwide
LASIK
Center for Refractive Surgery
PRK vs. LASIK
PRK
• Day one: “Oowww!”
• Less surgical risk
• Slower recovery
• 80% 20/20
• Haze possible
• No flap
LASIK
• Day one: “Wow!”
• Greater surgical risk
• Quicker recovery
• 80% 20/20
• No haze
• Flap
Do we need refractive
surgery in the military…
OPERATIONAL VISION CORRECTION
Over 1/2 million
soldiers, sailors and
airmen
40% require optical
correction
Annual cost of
optical corrective
devices…vast
OPERATIONAL VISION
CORRECTION
GLASSES
Traditional way to correct
all forms of refractive
error
Relatively inexpensive
Few complications
Very precise
GLASSES
• Disadvantages:
GLASSES
• Disadvantages:
GLASSES
Disadvantages:
Limit range of vision
Fogging, scratched
Broken or lost
Compatibility
problems-- with night
vision goggles,
protective mask inserts,
etc.
CONTACT LENSES
Advantages:
Cosmesis
Increased FOV
Less minification—
better vision in myopia
CONTACT LENSES
Disadvantages:
Difficult to clean in field
environment
May lead to infection
Problematic in chemical
environments
Dislodge with G-forces
REFRACTIVE SURGERY
All-weather 24/7 correction
Compatible with equipment
Increased soldier confidence
(no broken or fogged glasses)
Increased survivability
(lost glasses = casualty)
Improved quality of life--higher retention
ARMY POLICY
AR 40-501 prohibits entry with
history of refractive surgery, but…
Waiver policy (OTSG May 2000)
allows for PRK or LASIK if--At least 6 months since surgery
Meet AR 40-501 vision standards
ARMY POLICY
No visual side effects affecting
daily activities
Refractive error stability
Post-LASIK: excluded from HALO,
Flight, Diving and SF training
Post-PRK: excluded from Aviation
Center for Refractive Surgery
WRESP
Warfighter Refractive Eye Surgery Program
• WRESP -- limited resource available to commanders
to enhance mission readiness
Center for Refractive Surgery
WRESP
Warfighter Refractive Eye Surgery Program
• WRESP -- limited resource available to commanders
to enhance mission readiness
• MEDCOM establishing WRESP Laser Eye Centers in
MTFs designated by the DCSOPS
Center for Refractive Surgery
WRESP
Warfighter Refractive Eye Surgery Program
• WRESP -- limited resource available to commanders
to enhance mission readiness
• MEDCOM establishing WRESP Laser Eye Centers in
MTFs designated by the DCSOPS
• WRESP Centers: Operational -- Ft. Bragg Planned -Ft Campbell, Ft Hood, Tripler AMC, Landstuhl RMC
Center for Refractive Surgery
WRESP
Warfighter Refractive Eye Surgery Program
• WRESP -- limited resource available to commanders
to enhance mission readiness
• MEDCOM establishing WRESP Laser Eye Centers in
MTFs designated by the DCSOPS
• WRESP Centers: Operational -- Ft. Bragg Planned -Ft Campbell, Ft Hood, Tripler AMC, Landstuhl RMC,
• DHS allocates appointments to supported units
Center for Refractive Surgery
WRESP
Warfighter Refractive Eye Surgery Program
• WRESP -- limited resource available to commanders
to enhance mission readiness
• MEDCOM establishing WRESP Laser Eye Centers in
MTFs designated by the DCSOPS
• WRESP Centers: Operational -- Ft. Bragg Planned -Ft Campbell, Ft Hood, Tripler AMC, Landstuhl RMC,
• DHS allocates appointments to supported units
• Unit commands maintain by-name 3-month list
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
• 1st priority -- SOC; Infantry, Armor, Field Artillery
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
• 1st priority -- SOC; Infantry, Armor, Field Artillery
• 2nd priority-- CSS assigned to Division or Separate
Brigade
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
• 1st priority -- SOC; Infantry, Armor, Field Artillery
• 2nd priority-- CSS assigned to Division or Separate
Brigade
• Other service members -- space available
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
• 1st priority -- SOC; Infantry, Armor, Field Artillery
• 2nd priority-- CSS assigned to Division or Separate
Brigade
• Other service members -- space available
• At least 18 mo remaining on AD or with reenlistment
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
• 1st priority -- SOC; Infantry, Armor, Field Artillery
• 2nd priority-- CSS assigned to Division or Separate
Brigade
• Other service members -- space available
• At least 18 mo remaining on AD or with reenlistment
• At least 12 mo remaining with same/similar unit
Center for Refractive Surgery
WRESP Soldier Selection Criteria
Warfighter Refractive Eye Surgery Program
• Assigned to unit with mission at line-of-battle or
behind hostile lines
• 1st priority -- SOC; Infantry, Armor, Field Artillery
• 2nd priority-- CSS assigned to Division or Separate
Brigade
• Other service members -- space available
• At least 18 mo remaining on AD or with reenlistment
• At least 12 mo remaining with same/similar unit
• Must return for follow-up as specified
Center for Refractive Surgery
Womack Army Medical Center
Warfighter Refractive Eye Surgery Program
• AD Army, Navy and Marines at Ft Bragg
• To benefit Warfighter
(USASOC, 18th Airborne)
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1500 pts/year (3000 procedures); 125/month
USASOC—PRK only
All others—LASIK or PRK
LASIK disqualifying for SOC schools
(HALO, scuba, SFQC, SERE)
• Aviators—not eligible
NAVY POLICY
• Similar to ARMY for PRK
• Excludes LASIK unless in
research protocol
• WRESP Centers at San Diego,
Portsmouth, Bethesda
• Four others planned
AIR FORCE POLICY
• Waiver for PRK only
• Aviation and special duty
• Includes 200 rated aviators and
100 student aviators per year
• WRESP Center at Wilford Hall;
planned for AF Academy and
Wright-Patterson
Center for Refractive Surgery
Completed Navy Research
Initial Evaluation of PRK
Bottom line…
• 80% -- 20/20 UCVA
• 60% -- 20/16 UCVA
• >90% -- 20/20 on re-treatment
• Overall -- safe and effective
Center for Refractive Surgery
Completed Navy Research
Visual Recovery in PRK
Bottom Line…
• How long before 20/20 uncorrected VA?
- 40% at 1 week
- 81% at 4 weeks
- 81% at 12 weeks
• Prolonged recovery, transient CS loss
• Stable refraction in 6 weeks to 3 months
• Extended recovery period in PRK
Center for Refractive Surgery
Completed Navy Research
Pupil Size, Glare and Halos In PRK
Bottom line…
• No correlation: pupil size & symptoms
• No correlation: pupil size & pre- / post-op
visual performance differences
• Symptoms correlated with degree of
myopia
Center for Refractive Surgery
Completed Navy Research
Psychiatric Factors and Patient
Satisfaction After PRK
Bottom line…
• Overall: 92% happy with outcome
• The greater the depression before PRK-- less
happy and more regret after PRK
• Older patients: less happy, more regret
Center for Refractive Surgery
Completed Navy Research
NVG Performance and PRK
Bottom line…
• Slight VA and CS decrease at 2 weeks
• Returned to normal at 4 weeks
• Transient loss of NVG performance
Center for Refractive Surgery
Completed Navy Research
Quality of Vision & Prolonged Exposure
to Altitude
Bottom line…
• RK, PRK, LASIK groups
• All: slight corneal swelling (12-34 microns)
• Hyperopic shift large in RK, slight in
PRK/LASIK (0.2 – 0.3 D)
• Slight decrease in uncorrected and best
corrected vision
Center for Refractive Surgery
Completed Navy Research
Night Driving Simulation After PRK
Bottom line…
• Distance for detection of road signs
• Detection distances decreased in
symptomatic eyes & those with greater
light scatter
• Promising functional approach
Center for Refractive Surgery
Completed Navy Research
Vector Analysis Outcome of Astigmatic PRK
Bottom line…
• 20/20 UCVA in 73%
• Slight undercorrection of astigmatism
common
• Induced cylinder—rare
Center for Refractive Surgery
Completed Navy Research
Initial Evaluation of LASIK In Navy
Bottom line…
• 92% -- 20/20 UCVA at 12 months
• 70% -- 20/16 UCVA
• Slight decrease in CS, resolved 3 months
• 1 displaced flap at I day post-op
• Rapid return to duty
Center for Refractive Surgery
Ongoing/Future Naval Research
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Visual performance after PRK and LASIK
Initial evaluation of (INTACS)
Hyperopic PRK
Normative values for contrast sensitivity
Wavefront sensing
Cyclogyl vs tropicamide in refractive surgery
NEI refractive surgery questionnaire
PRK to retain ametropic Naval aviators
Center for Refractive Surgery
USAF PRK Study
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80 non-aviators, 20 controls; 30 months
Comprehensive ophthalmological baseline
Unique operational testing
Contrast sensitivity, color vision, NVGs, glare
disability, corneal haze detection
• Subsets: PRK at altitude
PRK under high Gz loads
PRK and cockpit visual simulation
Center for Refractive Surgery
Ongoing Air Force Research
Evaluation of PRK In Air Force
Bottom line…
• Nearly 100 subjects; all myopic
• Safe and effective thus far
• Mean values at 6 months:
UCVA
20/16
BSCVA
20/14
BSC SLCT 1.21
• Loss BSCVA and CS in some
Center for Refractive Surgery
Ongoing Air Force Research
High & Low Contrast Vision In PRK
Bottom line…
• Pre-op BSC vs post-op UC
• Decrease on each chart—
high contrast VA – 2 letters
low contrast VA – 5 letters
SLCT – 11 letters
• 24% require Rx for 20/20 in one eye
Center for Refractive Surgery
Ongoing Air Force Research
Contrast Sensitivity & Glare in PRK
Bottom line…
• Post-op decrease for middle/low SFs
• More marked decrease with glare and
dilation which persisted up to 1 year
• Likely due to refractive transition zone
Refractive Surgery In
Military Aviation
Center for Refractive Surgery
Walter Reed Health Care System
Washington, DC
Center for Refractive Surgery
FAA Policy on
Refractive Surgery
• PRK and LASIK authorized without waiver,
provided that…
• Post-operative condition has stabilized
• No significant adverse effects or
complications
• Pilot meets FAA vision standards
(Primary standard—corrected to 20/20 each eye)
Center for Refractive Surgery
Naval Aviation PRK Research
• Ongoing study--PRK in rated aviators with promising
results thus far
• Initiating study of pilots trainees at least three
months post-op to PRK
Air Force PRK Research
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80 non-aviators, 20 controls; 30 months
Basic vision and operational testing
Altitude, high Gz loads, cockpit simulation
Promising results thus far
Center for Refractive Surgery
Air Force Waiver for PRK
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Effective 2 Aug 00
Includes Aviation & Special Duty
Strict clinical criteria & follow-up
200 rated aviators/year; 100 pilot candidates
Must have PRK done at approved DoD site
Myopia only: -1 to –5.5; up to 3D astigmatism
No Current Navy or Army Aviation Waiver for PRK or
LASIK Unless In Research Protocol
Center for Refractive Surgery
Refractive Surgery & Army Aviation
USAARL Accession Study
• Initiated Feb 01
• Visual & flight performance of flight school
applicants who had laser surgery
• Enrollment criteria—3 months post-op, stable
refraction, class 1 flight standards
• 100 LASIK, 100 PRK, 100 controls
• Goal—determine if PRK/LASIK waiverable
Center for Refractive Surgery
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Refractive Surgery & Army Aviation
WRAMC/USAARL Accession Study
To begin Mar 02
Prospective study of visual & flight
performance of pilot trainees
Refractive surgery at WRAMC Center
40 PRK, 40 LASIK—matched for degree of preoperative refractive error
• Goals--determine if PRK/LASIK waiverable;
expand applicant pool; identify factors to
minimize risk and maximize performance
Center for Refractive Surgery
Refractive Surgery & Army Aviation
USAARL/WRAMC Rated Aviator Study
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Study approved Jan 02
UH-60 Black Hawk rated aviators
Refractive surgery at WRAMC Center
40 PRK, 40 LASIK—matched for degree of preoperative refractive error
• Comparison between flight performance
before surgery (with spectacle Rx) and
performance after surgery (without Rx)
• LASIK vs. PRK
Center for Refractive Surgery
Current Results
High Contrast Visual Acuity
D V N Z R
H N F V D
F U P V E
P E R Z U
F H P V E
Z R F N U
P R Z E U
F V P Z D
U P N H F
Night Vision Performance and
Visual Acuity After Photorefractive
Keratectomy
Barbara O’Kane, PhD, Raymond Stefanik,
James Stevens, Prem Subramanian, MD, PhD,
Jeff Rabin, OD, PhD, Robert Bauer, MD, PhD,
and Kraig Bower, MD
Center for Refractive Surgery
Walter Reed Army Medical Center
Washington, DC
US Army CECOM RDEC
Night Vision & Electronic Sensors Directorate Fort
Belvoir, VA
Introduction
• Vision often returns to
normal after refractive surgery
(eg, PRK or LASIK).
• Despite reports of decreased
night vision…
• Tests of night vision are lacking.
Introduction
• Military operations--at night
• Evaluation of efficacy & safety
of refractive surgery for
combat…
• Must include night vision
performance testing.
Research Purpose
To evaluate
 visual acuity through
night vision goggles
and
 detection of low contrast
targets
before and after PRK.
Summary of Methods
• 19 Special Operations soldiers received
PRK.
• All near-sighted before PRK (uncorrected
VA: 20/40 to 20/400).
• VA evaluated through NVGs
(before & 3 months after PRK).
• Detection of low contrast targets
(before & 3 months after PRK).
Results (next slide)
• Before PRK— NVG VA was
decreased when tested without
glasses.
• After PRK — NVG VA without
glasses as good or better than
pre-operative VA with glasses.
NVG Acuity and PRK
worse
Visual
acuity
(20/...)
better
180
160
140
120
100
80
60
40
20
Pre-op: no correction
Pre-op: with correction
Post-op: no correction
Post-op: with correction
mean + 1SE
n = 19
binocular data
Full
moon
1/4
Starlight
moon
Overcast
Starlight
Night sky condition
Results (next slide)
Acuity at Low Contrast
• Decrease in VA with decreasing letter
contrast.
• No difference between pre- and postop VA.
• Relation between VA & contrast
remained the same in all conditions.
Acuity and Contrast In PRK
160
worse
RE/Pre-op
RE/Post-op
LE/Pre-op
LE/Post-op
140
Visual
acuity
(20/...)
120
100
80
All values
with best
correction
60
40
better
mean + 1SE
n = 19
20
.1
1
10
Contrast (%)
100
Conclusions
• After PRK, NVG performance
(without glasses) as good or better
than performance before surgery
(with glasses).
• May translate to improved performance for
soldiers unable to wear glasses in combat.
Visual Performance In Soldiers:
One Year After PRK
Preliminary Results
Center for Refractive Surgery
Walter Reed Health Care System
Methods
• VA tested across range of
contrasts (1.25 - 100%)
• Small target CS
• Spatial and temporal CS
(sine-wave; 2 alternative forced choice)
• Photopic and mesopic testing
• With/without glare
High Contrast Visual Acuity
D V N Z R
H N F V D
F U P V E
P E R Z U
Logarithmic
progression in
letter size
F H P V E
Z R F N U
P R Z E U
F V P Z D
U P N H F
Low Contrast Visual Acuity
D V N Z R
H N F V D
F U P V E
P E R Z U
Rendition of 10%
contrast
F H P V E
Z R F N U
P R Z E U
F V P Z D
U P N H F
Low Contrast Visual Acuity
D V N Z R
H N F V D
F U P V E
P E R Z U
Rendition of 2.5%
contrast
F H P V E
Z R F N U
P R Z E U
F V P Z D
U P N H F
Low Contrast Visual Acuity
D V N Z R
H N F V D
F U P V E
P E R Z U
Rendition of
1.25% contrast
F H P V E
Z R F N U
P R Z E U
F V P Z D
U P N H F
Small Letter Contrast Sensitivity
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D
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V
U
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U
P
Z
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V N H P
Z E V H
Z N F U
V R N F
R E U Z
U E V H
R H U Z
H F V P
P R D U
F U P E
E Z N R
H Z E F
H D V R
F U V H
Visual Acuity and Contrast
1.2
worse
Mesopic
Photopic
Glare
20/200
0.9
Visual
acuity
(logMAR)
20/85
0.6
Mesopic
(nighttime)
0.3
Photopic
(daytime)
better
20/22
0.0
20/14
-0.3
.1
1
10
100
Letter contrast (percent)
1000
Spatial Contrast Sensitivity:
One Year After PRK
(minimum contrast to detect pattern as a function of pattern fineness)
100
Photopic
(daytime)
Contrast
sensitivity
(minimum contrast
for detection)
10
Mesopic
(nighttime)
(coarse ---------- pattern fineness ------------------ fine)
1
0.1
1
10
Spatial frequency (cycles/deg)
100
100
Temporal Contrast Sensitivity:
One Year After PRK
(minimum contrast to detect flicker as a function of flicker rate)
Photopic
(daytime)
Contrast
sensitivity
10
(minimum contrast
for detection)
Mesopic
(nighttine)
(slow ---------- flicker frequency ------------------ fast)
1
0.1
1
10
100
Temporal frequency (cycles/sec)
A New Test for Measuring
Glare Disability in
Refractive Surgery
Center for Refractive Surgery
Walter Reed Health Care System
Washington, DC
Introduction
• LASIK and PRK-- effective for
correction of refractive error
• Despite efficacy of refractive
surgery
• Many patients complain of glare…
• Particularly at night
Introduction
• Conventional glare testing-bright glare source under photopic
conditions
• Paradoxical improvement in vision
• Due to constriction of the pupil
• Which decreases effects of
peripheral aberrations
New Test of Glare Disability
• New approach to quantify glare
disability
• Which overcomes problems of
conventional tests
• By using contrast-modulated
stimulus
• Under reduced luminance to
encourage pupil dilation
New Test of Glare Disability
• Small letter contrast test
(20/25 letters varied in contrast)
• Viewed at low luminance (3 cd/m2)
• With and without diffuse surrounding
glare
• Chart luminance remains constant
with/without glare
• Minimal (<1mm) change in pupil size
Without glare
11
22
33
44
55
66
77
88
99
10
10
11
11
12
12
13
13
14
14
DD RR EE ZZ UU FF VV NN HH PP
RR PP FF DD UU NN ZZ EE VV HH
HH RR PP EE DD VV ZZ NN FF UU
ZZ EE DD HH PP UU VV RR NN FF
HH PP FF DD NN VV RR EE UU ZZ
RR ZZ FF DD PP NN UU EE VV HH
VV DD HH PP EE NN RR HH UU ZZ
UU RR NN EE DD ZZ HH FF VV PP
NN VV ZZ FF HH EE PP RR DD UU
DD VV NN ZZ RR HH FF UU PP EE
PP HH VV DD FF UU EE ZZ NN RR
RR VV UU NN DD PP HH ZZ EE FF
FF RR EE UU PP ZZ HH DD VV RR
EE RR PP DD NN ZZ FF UU VV HH
Viewed at low luminance
With glare
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N
F
N
V
U
V
N
N
Z
E
H
U
P
Z
Z
V N
Z E
Z N
V R
R E
U E
R H
H F
P R
F U
E Z
H Z
H D
F U
H
V
F
N
U
V
U
V
D
P
N
E
V
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P
H
U
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Z
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Z
P
U
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R
F
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H
Viewed at low luminance
Results
Glare Disability & Mesopic CS
1-Year After PRK
• Shift from photopic to mesopic...
8-line decrease in CS
• Addition of glare...
further decrease 3-lines
Glare Disability 1-Year After PRK
1.5
mean+2SE, n=18 eyes
1.2
Log small
letter
contrast
sensitivity
0.9
8 lines
0.6
0.3
3 lines
0.0
Photopic
Mesopic
Mes+Glare
Test condition
Results
Glare Disability & Mesopic CS
1-Year After PRK
• Infrared pupillometry under
mesopic conditions...
• Larger pupils--lower CS,
both with/without glare
• Suggests adverse effect of
peripheral aberrations
Mesopic CS, Glare & Pupil Size:
1-Year After PRK
0.7
0.6
Mesopic
Mes+Glare
0.5
Log small
letter
contrast
sensitivity
0.4
0.3
0.2
0.1
0.0
-0.1
-0.2
2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5
Mesopic pupil size (mm)
Center for Refractive Surgery
Future Research
Fixation Target
(adjustable focus)
Eye
Video Camera
Probe Laser
Wavefront Sensor
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
• Performance with night vision devices
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
• Performance with night vision devices
• Night firing
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
• Performance with night vision devices
• Night firing
• Land navigation
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
•
•
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Performance with night vision devices
Night firing
Land navigation
Helmet-mounted displays
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
•
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Performance with night vision devices
Night firing
Land navigation
Helmet-mounted displays
Flight training
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
•
•
•
•
•
•
Performance with night vision devices
Night firing
Land navigation
Helmet-mounted displays
Flight training
Night flight
Center for Refractive Surgery
Future research will assess the impact
of refractive surgery on…
•
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Performance with night vision devices
Night firing
Land navigation
Helmet-mounted displays
Flight training
Night flight
Performance of experienced aviators
Center for Refractive Surgery
Beyond 20/20
High Contrast Visual Acuity
D V N Z R
H N F V D
F U P V E
P E R Z U
F H P V E
Z R F N U
P R Z E U
F V P Z D
U P N H F
Small Letter Contrast Sensitivity
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P
Z
D
R
V
V
H
V
R
R
E Z
F D
P E
D H
F D
F D
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Z F
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V D
U N
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U F V N
U N Z E
D V Z N
P U V R
N V R E
P N U E
E N R H
D Z H F
H E P R
R H F U
F U E Z
D P H Z
P Z H D
N Z F U
In Pursuit of
Super-Normal Vision
H
V
F
N
U
V
U
V
D
P
N
E
V
V
P
H
U
F
Z
H
Z
P
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R
F
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Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
• In standard eye exam, we test for-near-sightedness, far-sightedness,
astigmatism
• Additional optical aberrations
(e.g., coma, spherical aberration)
• Also have a significant impact on vision.
Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
• Objective technique now exists for
comprehensive measurement of the optics
of the eye…
• Shack-Hartmann wavefront aberrometry
• Based on the shape of the wavefront of
light reflected from the eye.
Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
• Beam of light is reflected from the eye
• Through a micro-lens array producing a spot
image array of reflected light.
• Computer analysis determines relative
displacement of each spot image
• Used to compute local slope & character of
the wavefront of light.
Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
• The analyzed wavefront is used to derive
a correction profile
• Which can be used to—
guide laser eye surgery.
• FDA studies nearly complete verifying the
efficacy & safety of this approach.
Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
•
•
•
•
•
Our research & development includes…
State-of-the-art laser with eye tracking
Coupled with wavefront technology
Unique measures of visual performance
To achieve optimal vision for soldier &
civilian alike.
Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
• A correction which minimizes optical
aberrations will improve….
• Visual acuity—as much as 2x.
• Small target contrast sensitivity
(as much as 7x).
• And performance at night when pupil
becomes large.
Center for Refractive Surgery
Beyond 20/20
In Pursuit of Super-Normal Vision
What will Super-Normal
Vision look like??
Small Letter Contrast Sensitivity
Before correction
of aberrations
1
2
3
4
5
6
7
8
9
10
11
12
13
14
D
R
H
Z
H
R
V
U
N
D
P
R
F
E
R
P
R
E
P
Z
D
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V
V
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V
R
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F
P
D
F
F
H
N
Z
N
V
U
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P
Z
D
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H
D
D
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F
Z
D
N
U
D
U
U
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P
N
P
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D
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R
F
D
P
N
F
N
V
U
V
N
N
Z
E
H
U
P
Z
Z
V N H P
Z E V H
Z N F U
V R N F
R E U Z
U E V H
R H U Z
H F V P
P R D U
F U P E
E Z N R
H Z E F
H D V R
F U V H
Small Letter Contrast Sensitivity
After correction
of aberrations
1
2
3
4
5
6
7
8
9
10
11
12
13
14
D
R
H
Z
H
R
V
U
N
D
P
R
F
E
R
P
R
E
P
Z
D
R
V
V
H
V
R
R
E
F
P
D
F
F
H
N
Z
N
V
U
E
P
Z
D
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H
D
D
P
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F
Z
D
N
U
D
U
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D
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N
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D
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R
F
D
P
N
F
N
V
U
V
N
N
Z
E
H
U
P
Z
Z
V N H P
Z E V H
Z N F U
V R N F
R E U Z
U E V H
R H U Z
H F V P
P R D U
F U P E
E Z N R
H Z E F
H D V R
F U V H