Download Corneal Refractive Surgery Policy

DEPARTMENT OF THE NAVY
NAVAL RESERVE OFFICERS TRAINING CORPS
VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY
BLACKSBURG, VIRGINIA 24061
6490
Ser ;2.~ /
JUL 2 5
201~
COMMANDING OFFICER'S MEMORANDUM 6-14
From:
Commanding Officer, NROTC Unit, Virginia Polytechnic
Institute and State University
Subj:
ELECTIVE CORNEAL REFRACTIVE SURGERY POLICY
Encl:
(1) Corneal Refractive Surgery Checklist
(2) Pre - Operative Counseling Form
(3) Request to Have Refractive Surgery Letter
(4) Post - Op Medical Clearance Form
(5) Primary Care Provider Endorsement of Return to Full
and Unrestrict e d Duty Following CRS
(6) SNA-SNFO Acc e ssion PRK Wo r ksheet
(7) Requirements and Information for Post - LASIK Naval
Aviation Appl i cants
(8) Navy Aeromedical Reference and Wavier Guide Excerpt
(12.15 I 12.15B)
(9) MANMED 15 - 34, 15 - 35 , 15 - 36 Excerpts
(10) MANMED 15 - 102 Excerpt
1. Background.
This po li cy letter outlines the process for
interested Midshipmen to attain approval for elective corneal
refractive surgery (PRK/LASIK).
This elective surgery may
correct visual acuity deficiencies and lead to favorable
consideration for av i ation or special warfare billets in the
Navy and Marine Corps upon commissioning. On the other hand, no
guarantee exists that surgery will correct one's vision
deficiency to Naval Aviation or Spec i a l Warfare/Special
Operations standards.
In some cases , surgery degrades existing
visual acuity and has led to disqualification for commissioned
service.
2.
Policy.
a.
Enclosures (1) through (10) provide specific guidance
for Midshipmen interested in Corneal Refractive Surgery (CRS)
b.
Caution should be used in selecting surgeons and
surgical methods for CRS.
Brand names, marketing strategies and
technological advances often cause confusion regarding CRS
terminology.
Photorefractive Keratectomy (PRK) and Laser in situ keratomileusis (LAS I K) are the ONLY Navy approved CRSs.
Subj:
ELECTIVE CORNEAL REFRAC TIVE SURGERY POLICY
All other forms of CRS including Radial Keratotomy (RK), Laser
Thermal Keratoplasty, and Intracorneal Ring (ICR) are
PERMANENTLY DISQUALIFYING.
c.
Review enclosure (1) and comply with the requirements
specified in enclosure (2).
Enclosure (2) serves as a statement
of understanding that:
(1) the surgery is elective,
(2) scheduled ent i rely by the Midshipman and not to
interfere with academi cs or NROTC program requirements,
(3) performed by certified health care provider with all
costs covered by the Midshipman,
(4) medical disqualification for commissioning may
result, which may lead to reimbursement of all educational
benefits received.
d.
Using enclosure (3) submit a written request seeking
approval for elective CRS (PRK/LASIK) to Commanding Officer,
Naval ROTC Unit Virginia Tech via your Class Advisor.
e.
For PRK, arrange for a refractive test and submit preoperative exam(s), operative report, and post - operative followup reports to the Unit Midshipman Medical Qualifications
Coordinator for submission to the Bureau of Medicine and
Surgery. These reports assist in preparing a medical (visual
acuity) waiver request to Naval Operational Medical Institute,
Pensacola, FL or Undersea Medicine and Radiation Health
(M3/5FP).
f.
For LASIK, schedule and obtain a post - operative followup from a designated Navy Medical Treatment Facility as listed
in enclosure (7).
Submit pre - operative exam(s), operative
report, and post-operative follow - up reports to the Unit
Midshipman Medical Qualifications Coordinator for submission to
the Bureau of Medicine and Surgery.
These reports assist in
preparing a medical (visual acuity) waiver request to Naval
Operational Medical Institute, Pensacola, FL or Undersea
Medicine and Radiation Health (M3/5FP).
3.
Summary.
CRS serves as a means to correct vision
deficiencies to become competitive for a medical waiver to enter
the Naval Aviation or Special Warfare/Special Operations
Subj:
ELECTIVE CORNEAL REFRACTIVE SURGERY POLICY
communities. All risks and associated costs should be
considered when contemplating this elective surgical procedure.
4.
Points of Contact.
The Unit Midshipman Medical
Qualifications Coordinator and Aviation Programs Officer serve
as my technical experts on this issue and will periodically
review this policy to recommend updates as appropriate.
CORNEAL REFRACTIVE SURGERY CHECKLIST FOR NROTC MIDSHIPMEN AND
OFFICER CANDIDATES
____ 1. Read and understand the CO’s “ELECTIVE CORNEAL
REFRACTIVE SURGERY POLICY” including enclosures (1) through
(10).
____ 2. Read and understand the Pre-Op Counseling Form,
enclosure (2).
____ 3. Read, discuss, and sign with your Class Advisor the
Pre-op Counseling Form For NROTC Midshipmen and Officer
Candidates Undergoing Corneal Refractive Surgery, enclosure (2).
____ 4. Review with the doctor performing your surgery and
ensure that you meet the pre-operative requirements and the
anticipated post-operative outcomes to meet specific Naval
community expectations (e.g. enrollment into the Aviation LASIK
study).
____ 5. Obtain from your doctor a written and signed
acknowledgment that you meet pre-operative requirements. Ensure
this acknowledgement lists the type of procedure to be performed
(PRK/LASIK), and anticipated outcome.
____ 6. Request in writing from your NROTC Unit Commanding
Officer, permission to have the surgery performed, enclosure
(3). Include with this request all documentation acquired in
step 5 and the signed Pre-op Counseling Form from step 3.
____ 7. With the Commanding Officer’s approval have the surgery
performed.
____ 8. Have your doctor complete the Post-Op Medical Clearance
Corneal Refractive Surgery form, enclosure (4), and return the
completed form to the NROTC Unit.
If you intend to select Aviation:
____ 8a. PRK & LASIK aviation applicants, have your doctor
complete the SNA-SNFO Accession CRS Worksheet, enclosure
(6). Return this form to the Unit.
____ 8b. LASIK aviation applicants, schedule and complete
additional ocular tests at one of the ten designated MTFs
listed in enclosure (7). This is a requirement to be
Enclosure (1)
enrolled in the “LASIK in Naval Aviation Study.”
any follow-up information to the Unit.
Return
____ 9. At least three months must elapse from date of surgery
or re-treatment, during which you must have at least two postoperative eye examinations separated by at least one month to
show evidence of stable refractive error. These examinations
must include visual acuity and refraction.
____ 10.
error
-
Collect all CRS records, to include:
detailed clinical records of the pre-operative refractive
operative report including type of procedure
records of the two post-operative examinations
PRK Accession Worksheet/LASIK follow-up records
any other pertinent records.
Give these records to the Unit Midshipmen Medical Qualifications
Coordinator. A waiver request to BUMED (M3F) will be submitted
via your chain-of-command for “History of Laser Eye Surgery.”
Enclosure (1)
PRE-OP COUNSELING FORM FOR NROTC MIDSHIPMEN AND OFFICER
CANDIDATES CONSIDERING CORNEAL REFRACTIVE SURGERY
1. I, _______________________________________ (Rank/Rate, First
name, Middle Initial, Last name) am seeking health care outside
a federal source for corneal refractive surgery. My initials
next to each of the following paragraphs indicate I have read
and understand each section.
____ 2. I acknowledge I have read and understand the
applicable references.
If I desire to serve in Naval Aviation:
___ I acknowledge that I have read and understand
enclosure (8) U.S. Navy Aeromedical Reference and Wavier
Guide sections 12.15 and 12.15B and enclosure (7)
“Requirements and Information for Post-LASIK Naval Aviation
Applicants.” (LASIK only).
If I desire to serve in Special Warfare / Special
Operations:
___ I acknowledge that I have read and understand
enclosure (9) MANMED 15-34 and enclosure (10) MANMED 15-102
regarding the post-operative requirements for entry into
the Special Warfare / Special Operations communities.
The purpose of this counseling is to inform me of current
guidance I need to be aware of prior to having elective
non-Military Health Care system surgery performed at my own
expense. The purpose of this counseling is not to
determine my actual suitability for corneal refractive
surgery, as that determination must be made by my eye care
provider.
____ 3. I understand there are different types of corneal
refractive surgery, and that I may subsequently be found
disqualified from entry into certain warfare communities,
depending on the type of surgery that is performed on my eyes.
It is my responsibility to know the current policy on refractive
surgery in my desired warfare community.
____ 4. I understand that I must obtain the prior approval of
my command to have corneal refractive surgery. Any time away
from work required as part of the pre-operative evaluation,
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (2)
surgery and post-operative follow-up must be approved by my
command.
____ 5. I have been notified that I am responsible for all
expenses associated with the pre-operative evaluation, surgical
fees and post-operative care. The government is not responsible
for out-of-pocket expenses that I may incur by an insurance
carrier, or that I am unable to pay as part of the cost of the
contemplated care.
____ 6. I understand that after I have had my surgery in the
civilian community, post-operative follow-up care will not be
performed by a military treatment facility (MTF).
____ 7. I understand that if I obtain LASIK surgery and wish to
commission as a Naval Aviator I must have additional ocular
tests performed at one of the ten designated military treatment
facilities listed in enclosure (7). I am responsible for all
travel expenses and scheduling of this appointment.
____ 8. I have been provided with a copy of the Medical
Clearance Form for Return to Full and Unrestricted Duty
Following Corneal Refractive Surgery. I have been directed to
have my eye care provider complete this form after my surgery.
I will return it to the Uniform Services Medical Facility where
my outpatient records are kept, at which time a determination
for fitness and continued service may be made by a medical
department representative.
____ 9. I understand that any form of corneal refractive
surgery disqualifies me physically for a commission in the Navy
or Marine Corps and that I must request a waiver for this
disqualification prior to commissioning.
____ 10. I understand that if I am to request aviation as my
service assignment and I elect to undergo LASIK surgery, I must,
in addition to my waiver request, be accepted in the Navy’s
“LASIK in Naval Aviation” study.
____ 11. In the event of an irreversible adverse outcome that
affects the ability to perform the duties of a commissioned
officer I understand that I may be physically disqualified for
commissioning and may be responsible for recoupment of my
college tuition costs to the Navy.
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (2)
____ 12. I understand that by having this surgery performed it
in no way guarantees that I will be selected for aviation,
special warfare, or any other warfare community. I must still
meet all other requirements set by the respective communities.
____ 13. I have had my questions answered and understand that
this document will be placed in my outpatient medical record. I
understand that my commissioning may be delayed for possibly one
year after surgery.
__________________
Midshipman
Signature
_______________
Class Advisor
Signature
__________________
Commanding Officer
Signature
__________________
Date
_______________
Date
__________________
Date
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (2)
DD MMM YY
From:
To:
Via:
MIDN 3/C John T. Smith, USNR/USMCR
Commanding Officer, NROTC Unit, Virginia Polytechnic Institute
and State University
(1) Company Advisor
(2) Executive Officer, NROTC Unit, Virginia Polytechnic Institute
and State University
Subj:
REQUEST TO HAVE CORNEAL REFRACTIVE SURGERY
Ref:
(a) CO NROTC Unit Virginia Tech CRS Policy dtd 13 Jul 11
ENCL:
(1) Corneal Refractive Surgery Checklist for NROTC Midshipmen and
Officer Candidates
(2) Pre-Op Counseling for NROTC Midshipmen and Officer Candidates
Considering Corneal Refractive Surgery
1. I have thoroughly reviewed reference (a) and the Navy’s policy concerning
refractive surgery in the civilian sector and will comply with all
requirements and expectations placed upon me. My estimated commissioning
date is DD MMM YY. I understand that a waiver will be necessary for
commissioning and that the surgery may create complications that would
physically disqualify me from service in the Navy. I also understand that
all costs and follow-up procedures are solely my responsibility.
2.
I respectfully request approval to have refractive surgery performed.
___________________
Signature
FIRST ENDORSEMENT
____________
Date
From:
To:
Company Advisor
Executive Officer, NROTC Unit, Virginia Polytechnic Institute
and State University
1.
Recommend approval/disapproval.
2.
Reason: _________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__________________
Signature
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (3)
Subj:
REQUEST TO HAVE CORNEAL REFRACTIVE SURGERY
SECOND ENDORSEMENT
____________
Date
From:
To:
Executive Officer, NROTC Unit, Virginia Polytechnic Institute
and State University
Commanding Officer, NROTC Unit, Virginia Polytechnic Institute
and State University
1.
Recommend approval/disapproval.
2.
Reason: _________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_________________
Signature
THIRD ENDORSEMENT
____________
Date
From:
To:
1.
Commanding Officer, NROTC Unit, Virginia Polytechnic Institute
and State University
MIDN 3/C John T. Smith, USNR/USMCR
Approved/Disapproved.
___________________
Signature
Copy to:
Company Advisor
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (3)
POST-OP MEDICAL CLEARANCE AFTER CORNEAL REFRACTIVE SURGERY
From:
____________________________________ (Name of eye care provider)
____________________________________ (Address)
____________________________________
(____)______________________________ (Office phone number)
To:
Service Member’s Primary Care Provider
Subj:
MEDICAL CLEARANCE FOR ______________________________________
(Rank/Rate, First name, Last name) TO RETURN TO FULL AND
UNRESTRICTED DUTY FOLLOWING CORNEAL REFRACTIVE SURGERY
1. The above named service member had __________________________ (type of
corneal refractive surgery) performed in the right eye / left eye / both
eyes on __________________ (date). As a military or civilian eye care
provider (ophthalmologist or optometrist) that has evaluated the service
member following his/her surgery, the purpose of this letter is to
recommend when he or she may return to work on a full time basis without
any further restrictions based on the guidelines provided in paragraphs (2)
and (3). I understand this document will be placed in the service member’s
outpatient military health record.
2. I understand that most service members are able to resume routine daily
work activities within a few days after surgery. However, due to the need
for follow-up care in the immediate post-operative time period, service
members usually will not be returned to full and unrestricted duty until
approximately 1 month following surgical correction of myopia, and possibly
as long as 3 to 4 months after surgical correction of hyperopia. Full and
unrestricted duty is defined as the ability to perform all job
responsibilities of their rank/rate, as well as being suitable for
deployment to isolated duty locations where routine eye care services are
not readily available.
3. I certify that the following pre-requisites for full and unrestricted
duty assignment have been met:
a. All topical eye drops (including steroids or anti-inflammatory
agents) have been discontinued. Artificial tears may be used as needed.
b. Post-operative BEST CORRECTED visual acuity is greater than or
equal to 20/20 in each eye that had surgery, OR is within one line of the
BEST CORRECTED pre-operative visual acuity in each eye that had surgery:
Best corrected visual acuity PRE-OP =
Best corrected visual acuity POST-OP =
Uncorrected visual acuity POST-OP =
c.
20/___ OD, 20/___ OS.
20/___ OD, 20/___ OS.
20/___ OD, 20/___ OS.
There are no visually debilitating symptoms related to surgery.
4. I recommend that the service member may return to full and unrestricted
duty as of _________________________(date).
________________________________
(Signature of eye care provider)
________________
(Date)
FOR OFFICIAL USE ONLY –PRIVACY SENSITIVE: ANY MISUSE OR UNAUTHORIZED
DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (4)
PRIMARY CARE PROVIDER ENDORSEMENT OF RETURN TO FULL AND UNRESTRICTED DUTY
FOLLOWING CORNEAL REFRACTIVE SURGERY
1. I have reviewed the Medical Clearance Form for Return to Full and
Unrestricted Duty Following Corneal Refractive Surgery ICO
__________________________________ (Rank/Rate, First name, Last name).
2. As part of the fitness for duty, I have determined if the service
member’s job occupation requires a minimum specified visual acuity
requirement in order to perform her or his duties (as listed in the Manual
of Medical Department). The uncorrected visual results following surgery
must meet those specified standards. If the service member’s uncorrected
visual acuity following surgery does not meet the specified standards,
then the member must have received additional vision correction in the
form of glasses or contact lenses that enables him or her to fulfill the
visual acuity requirements before returning to duty.
3. In accordance with current BUMED guidance, I have verified that the
type of corneal refractive surgery the service member had performed does
not disqualify her/him from retention on active duty in his or her current
NEC or NOBC.
4a. The service member’s eye care provider (military or civilian) has
verified that all of the prerequisites identified in paragraphs 3(a) –
3(c) of the Medical Clearance form have been satisfied. Effective
________________________ (date), the service member may return to full and
unrestricted duty, which is defined as the ability to perform all job
responsibilities of their rank/rate, as well as being suitable for
deployment to isolated duty locations where routine eye care services are
not readily available.
OR
4b. One or more of the prerequisites identified in paragraph (3) of the
Medical Clearance form were not satisfied, but the service member has been
evaluated by a military ophthalmologist or optometrist and has been
recommended for return to full and unrestricted duty effective
_________________________ (date).
____________________ ____________
Provider’s signature Rank/Rate
_____________________
Printed name or stamp
_______
Date
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE: ANY MISUSE OR UNAUTHORIZED
DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (5)
SNA/SNFO Accession CRS Worksheet
Ref:
(1) BUMED 051824Z DEC 01 LASER EYE SURGERY PRK IN NEW ACCESSIONS TO
NAVY AND MARINE CORPS/AVIATION CLINICAL STUDY CHANGE IN STUDY
ENROLLMENT CRITERIA.
(2) BUMED WASHINGTON DC 261240Z FEB 02 AVIATION CLINICAL STUDY CHANGES
IN STUDY ENROLLMENT CRITERIA.
(3) ALNAV 047/01 112050Z MAY 01 AVIATION VISION STANDARDS CHANGE.
(4) http://www.nomi.med.navy.mil/Nami/WaiverGuideTopics/exams.htm#sna
1. History of corneal refractive surgery (CRS) is disqualifying. Waiver may be
recommended if member meets requirements in references, although Study enrollment is no
longer required.
2. Caution should be used in selecting surgeons and surgical methods for CRS. Brand
names, marketing strategies and technological advances often cause confusion regarding CRS
terminology. Photorefractive Keratectomy (PRK) and Laser in-situ keratomileusis (LASIK)
are the ONLY Navy approved CRSs. All other forms of CRS including Radial Keratotomy (RK),
Laser Thermal Keratoplasty, and Intracorneal Ring (ICR) are PERMANENTLY DISQUALIFYING.
3. Member must have completed all eye medication and be without visual complaints prior to
submission.
4. Post-operative refractive stability is demonstrated by comparing two consecutive
manifest refractions which must not differ by more than 0.50 D in either sphere or cylinder
or both in either eye, and which must be separated by at least one month.
5. The interval after surgery prior to performing final manifest refraction and then
submitting this worksheet depends on the preoperative refractive error, as follows:
6.
Plano to –5.50 total diopter sphere: three months;
7.
-5.75 to –8.00 or +0.25 to +6.00 total diopter sphere: six months.
8. If the initial pair of post-operative manifest refractions does not demonstrate
stability, repeat a manifest refraction at one month intervals until they are stable and
report only the final two.
9. Note: all SNA candidates require a post-operative cycloplegic refraction recorded on
the SF-88.
10. SNA/SNFO accessions must meet all other aviation vision standards; history of CRS does
not guarantee selection for nor completion of flight training.
SUBMIT to NAMI Code 42/MED-236 Aeromedical Physical Qualifications all of the following:
•
•
•
•
•
This worksheet, completed per the references.
Copy of pre-operative evaluation at treating Laser Center.
Copy of operative note for each eye treated (computer printout from laser).
Copies of all post-operative eye notes, including manifest refractions at required
intervals.
Candidate SNA/SNFO SF-88 with required attachments, requesting waiver for history of
PRK. (Do not submit an aeromedical summary—AMS—which is not appropriate for a
candidate for air warfare duty.)
Last name:_____________________ First:__________________ Middle:_____________
DOB:__________
Military status (civ; OC; Midn; or rank/rate & service):________________
Date of surgery: OD ______ OS_______ Location of surgery:________________________________
OD OS
sph cyl axis sph cyl axis
Pre-operative manifest refraction: _____ _____ _____ _____ _____ _____
Post-operative manifest refraction #1: date________ _____ _____ _____ _____ _____ _____
Post-operative manifest refraction #2: date________ _____ _____ _____ _____ _____ _____
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (6)
Above data has been carefully reviewed and is compliant with standards in paragraphs 4 - 9
Post-operative cycloplegic refraction (SNA only) _____ _____ _____ _____ _____ _____
Final uncorrected Goodlite/AFVT distant visual acuity: 20/_______ 20/_______
Final best corrected Goodlite/AFVT distant visual acuity: 20/_______ 20/_______
Submitter:____________________________________________________________ Date:_________
Refer questions to NAMI Code 323, Captain W. Anderson, 850 452-2257 ext 1020,
[email protected] 28 Sep 04
FOR OFFICIAL USE ONLY – PRIVACY SENSITIVE:
ANY MISUSE OR UNAUTHORIZED DISCLOSURE MAY RESULT IN BOTH CIVIL AND CRIMINAL PENALTIES
Enclosure (6)
REQUIREMENTS AND INFORMATION FOR
POST-LASIK NAVAL AVIATION APPLICANTS
ELIGIBILITY CRITERIA
1. Wavefront-guided (e.g., VISX CustomVue, or equivalent) or wavefront-optimized and
femtosecond keratome (e.g., IntraLase, or equivalent) LASIK procedure is STRONGLY
ENCOURAGED as the LASIK treatment of choice in Naval Aviation. Applicant cannot
have post-operative higher-order ocular aberrations in excess of 0.7 microns as measured by
a Hartmann-Shack aberrometer AND best corrected low contrast visual acuity better than or
equal to 0.50logMAR using a specified 25 percent contrast chart.
2. Accepted into a U.S. Navy-approved “LASIK in Naval Aviation” study protocol for longterm follow-up.
3. Pre-LASIK refractive error (measured after dilation) must not exceed -8.00 to +3.00 diopters
(spherical equivalent) and 3.00 diopters of cylinder. Pre-LASIK anisometropia should not
exceed 3.50 diopters (using spherical equivalent for each eye).
4. Post-LASIK SNA/SNFO/aircrew applicants must meet refractive, cycloplegic, and vision
standards as defined by the Manual of Medicine, Chapter 15.
5. Applicants must provide detailed pre-LASIK, operative, and post-LASIK records prior to
acceptance into a Navy-approved LASIK study.
6. At least three months have elapsed since LASIK surgery or re-treatment and evidence of
stable refractive error is demonstrated by two separate examinations performed at least one
month apart.
7. Meet all other applicant entrance criteria as delineated in the Manual of the Medical
Department (NAVMED P117) and BUMED/30MAR2000/SER 25/NOTAL (refractive
surgery policy in the Navy and Marine corps for new accessions) and as specified by
approved aviation LASIK study protocols.
Enclosure (7)
18 Nov 2008
ACCESSION GROUP PROCEDURES
CIVILIAN ACCESSION: All of the necessary paperwork regarding LASIK (i.e., preoperative
exam(s), operative report, and post-operative follow up) shall be assembled by the applicant.
Information will be reviewed and additional ocular tests performed during the preflight physical
exam at Officer Candidate School (OCS) in Newport, RI. If within waiver criteria for LASIK
and meeting all other physical exam requirements, candidates will begin training at OCS. They
will be offered enrollment into the “LASIK in Naval Aviation” study at the beginning of flight
training in Pensacola, FL (during their Naval Aerospace Medicine Institute (NAMI)
examination).
NROTC ACCESSION: Potential NROTC applicants shall obtain approval from their
Commanding Officer to undergo LASIK at their own expense at a civilian institution. All of the
necessary paperwork regarding LASIK (i.e., preoperative exam(s), operative report, and postoperative follow up) shall be assembled by the applicant. In conjunction with the standard
preflight physical, a designated Navy Medical Treatment Facility (see below for listing) will
perform additional ocular tests and review gathered information. If within waiver criteria for
LASIK and meeting all other physical exam requirements, candidates will be offered enrollment
into the “LASIK in Naval Aviation” study at the beginning of flight training in Pensacola, FL
(during their NAMI examination).
USNA ACCESSION: Potential midshipmen applicants shall obtain approval from the
Commandant to undergo LASIK either (1) at a Navy Refractive Surgery Center or (2) at their
own expense at a civilian institution. All of the necessary paperwork regarding LASIK (i.e.,
preoperative exam(s), operative report, and post-operative follow up) shall be assembled by the
applicant. In conjunction with the standard preflight physical, the USNA Optometry Clinic will
perform additional ocular tests and review gathered information. If within waiver criteria for
LASIK and meeting all other physical exam requirements, candidates will be offered enrollment
into the “LASIK in Naval Aviation” study at the beginning of flight training in Pensacola, FL
(during their NAMI examination).
ACTIVE DUTY ACCESSION: Potential active duty applicants shall obtain approval from their
commanding officer to undergo LASIK via established guidelines. Applicants will then apply for
aviation training and/or re-designation in accordance with Navy regulations. All of the necessary
paperwork regarding LASIK (i.e., preoperative exam(s), operative report, and post-operative
follow up) shall be assembled by the applicant. If selected for further processing, applicants will
have a screening ophthalmic examination conducted at a designated Navy Medical Treatment
Facility (see below for listing). If within waiver criteria for LASIK and meeting all other
physical exam requirements, candidates will be offered enrollment into the “LASIK in Naval
Aviation” study at the beginning of flight training in Pensacola, FL (during their NAMI
examination).
Enclosure (7)
18 Nov 2008
DESIGNATED MEDICAL TREATMENT FACILITIES
The following U.S. Navy Medical Treatment Facilities are properly equipped and qualified to
perform the additional ocular measurements required for Naval Aviation applicants with a
history of LASIK surgery:
1.
National Naval Medical Center
Laser Vision Center
8901 Wisconsin Ave
Bethesda, MD 20889
301-295-1200
6.
Naval Hospital Bremerton
Department of Ophthalmology, Code 044
Bremerton, WA 98312
360-475-4579
Naval Medical Center Portsmouth
620 John Paul Jones Circle
Refractive Surgery Center
Portsmouth, VA 23708
757-953-7575
7.
Naval Hospital Camp Pendleton
Department of Ophthalmology, SC-MSI
Camp Pendleton, CA 92055-5191
760-725-6641
Naval Hospital Camp Lejeune
Refractive Surgery Center
100 Brewster Boulevard
Jacksonville, NC 28547
910-450-3353
8.
Navy Refractive Surgery Center
Naval Medical Center San Diego
2051 Cushing
San Diego, CA 92106
619-524-5511
Naval Hospital Jacksonville
Department of Ophthalmology
2080 Child Street
Jacksonville, FL 32214
904-542-7680
9.
Naval Health Clinic Annapolis
Optometry Department
250 Wood Road
Annapolis, MD 21402-5050
410-293-1790
Naval Aerospace Medicine Institute
Eye Department
340 Hulse Road
Pensacola, FL 32508
850-452-2257
10. NHCNE Newport
Optometry Department
43 Smith Road
Newport, RI 02841-1102
401-841-3666
2.
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Enclosure (7)
18 Nov 2008
12.15 CORNEAL REFRACTIVE SURGERY (PRK/LASIK)
AEROMEDICAL CONCERNS:
Definitions:
Corneal Refractive Surgery (CRS): A laser is used to reshape the anterior corneal surface
reducing refractive error and reliance on spectacles or contact lenses. A “wavefront-guided”
(WFG) or “custom” procedure uses wavefront analysis technology, and may improve the visual
outcome of the procedure.
Photorefractive Keratectomy (PRK) or Laser-Assisted Epithelial Keratectomy (LASEK) :
Laser energy is applied to the anterior corneal surface after the epithelium is temporarily
displaced or removed. No corneal flap is created. PRK variants include LASEK (epithelium is
preserved), and Epi-LASIK (epithelial flap is created). Pain can be moderate to severe, and
visual recovery can take months.
Laser in-situ keratomileusis (LASIK): A cornea stromal flap is created with a surgical blade or
infrared laser after which, an excimer laser is used to reshape the exposed corneal stroma. The
corneal flap is then repositioned. Pain is minimal and vision recovery is much faster than PRK.
All forms of refractive surgery are disqualifying for aviation duty, but waivers are readily
granted if the member meets all waiver guide policy guidelines. Designated members who
undergo refractive surgery shall be grounded at the time of surgery, but a grounding physical is
not required. Designated members shall not return to flight duty until a Local Board of Flight
Surgeons (to include one eye provider) recommends a waiver via an Aeromedical Summary
(AMS) and issues a ninety-day temporary aeromedical clearance notice.
Both PRK and LASIK are waiverable at this time (see specific sections below).
All other forms of refractive surgery, or any vision or corneal manipulation or surgery,
including RK (radial keratotomy), LTK (laser thermal keratoplasty), ICR (intracorneal ring),
ICL (intraocular corrective lens), and clear lens extraction, are permanently disqualifying
(CD/WNR) for all aviation duty Class I, II and III personnel. The prior use of orthokeratology
(rigid contact lens corneal reshaping) is NCD provided that it is permanently discontinued prior
to obtaining flight status and all appropriate refractive standards are met with stable topography.
U.S. Navy Aeromedical Reference and Waiver Guide
Ophthalmology - 20
PRK AND LASIK GENERAL GUIDELINES (applicants and designated personnel)
1. Post-operatively, the member must still pass all MANMED vision standards for their
class or applicant status, and must wear corrective lenses while flying, if required, to
achieve the vision standard.
2. Refractive stability and a satisfactory postoperative slit lamp exam is required. Trace
peripheral haze or scarring that is considered stable by the eye care provider, and not
visually significant, is not a hindrance to waiver.
3. There must be no symptoms that would be cause for concern when considering the
performance of the member’s usual flight duties, including, but not limited to, severe dry
eye, recurrent corneal erosions and visually significant glare, haloes, or central scarring.
4. A subsequent PRK or LASIK enhancement or “touch-up” must meet the same timeframe
and clinical guidelines, and requires a second waiver submission package and AMS.
5. Wavefront-guided, or “custom”, PRK or LASIK is preferred, but in no way is required
for a waiver recommendation. This custom treatment may increase visual acuity and
final vision outcomes significantly, but not all patients are candidates for custom
treatments.
6. Copies of all pre-operative, and post-operative examination paperwork, including the
laser treatment reports, are required for waiver considerations. NAMI may request
additional information as deemed medically necessary to make a waiver determination.
7. For PRK and LASIK waiver renewal, submission is as stated in the member’s BUMED
waiver letter. In general, those enrolled in the LASIK studies require annual submission.
All others only require routine five-year submission.
Applicants only:
1. All applicants for Naval aviation must satisfy the above general guidelines and the
following more specific guidelines:
2. Civilian applicants must obtain PRK or LASIK at their own expense at a civilian
refractive surgery center. Active duty applicants may apply for waiver whether their
surgery was performed at a civilian refractive surgery center prior to joining the military,
or at a military RSC. The minimum wait time before submitting a waiver request for
applicants is six months from the date of surgery. All paperwork and operative reports
must be available and submitted for waiver consideration. See section 12.15B for
additional information and requirements for LASIK in Student Naval Aviators.
3. SNA applicants: pre-operative refractive error must not exceed -8.00 to + 3.00 (SE) and
3.00 diopters of cylinder, with no more than 3.50D of anisometropia. They must
additionally have a post-operative cycloplegic refraction using cyclopentolate performed
at a military installation.
U.S. Navy Aeromedical Reference and Waiver Guide
Ophthalmology - 21
SPECIFIC PRK AND LASIK GUIDELINES (cont):
Active duty designated aviation personnel only:
1. Designated aviation personnel must satisfy all the above general guidelines and the
following guidelines:
2. A PRK waiver request may be submitted for:
a. myopia -6.00 diopters or less spherical equivalent (SE): 3 months
b. myopia greater than -6.00 diopters SE: 6 months
c. hyperopia SE: 6 months
3. A LASIK waiver request may be submitted for:
a. myopia: 2 weeks
b. hyperopia and mixed astigmatism: 4 weeks
4. If still requiring prescription topical medication (Restasis or cyclopsporine drops
excluded) then restriction of flight activities to the local area is recommended.
5. Class I aviators, specifically, must undergo PRK or LASIK treatment at one of the USN
designated refractive surgery centers (includes Tripler AMC and Keesler AFB, which
have Navy ophthalmology support). (See section 12.15A for additional information)
6. Class II, III, and other flight personnel (e.g. select passengers) may undergo PRK or
LASIK at any DoD refractive surgery center.
7. For PRK, there are no pre-operative refractive limits for already designated personnel
within their aviation class. For LASIK, waivers may be granted for myopia up to -11.5D
spherical equivalent with no more than 3.5D of astigmatism, and hyperopia up to +3.75D
spherical equivalent with no more than 2.75D of astigmatism.
8. Regardless of prior designated aviation class, any personnel applying for SNA status
must abide by all MANMED and waiver policy guidelines and refractive limits for SNA
applicants.
9. The CRS/PRK AMS template (available on the NAMI website) may serve as a Local
Board of Flight Surgeons, following review and endorsement by two flight surgeons, plus
an eye care provider (military optometrist or ophthalmologist), and commanding officer
approval. A ninety-day aeromedical clearance notice may be issued at that time, pending
BUPERS waiver approval. Submit the AMS and waiver package immediately to NAMI
to avoid unnecessary delays in obtaining BUPERS final approval.
10. No deployment for at least three months following PRK and one month following LASIK
surgery (per BUMED policy).
U.S. Navy Aeromedical Reference and Waiver Guide
Ophthalmology - 22
SPECIFIC PRK AND LASIK GUIDELINES (cont):
Select Reserve designated aviators:
1. Reservists must satisfy all the above general guidelines and the following guidelines:
2. May obtain PRK or LASIK at their expense from civilian sources of care.
3. A pre-operative evaluation is strongly encouraged to be submitted to NAMI
Ophthalmology before corneal refractive surgery is performed. Contact NAMI
Ophthalmology at 850-452-2933 or [email protected].
4. Final approval to proceed with PRK or LASIK requires written permission from the unit
commander and unit flight surgeon.
REFRACTIVE SURGERY DISCUSSION:
The goal of corneal refractive surgery is to reduce or eliminate dependence on spectacles or
contact lenses, which can be bothersome at times while flying. Refractive surgery has been
studied extensively in the aviation environment and has yielded highly satisfying results. More
than 95% of Naval Aviators reported “increased effectiveness” after undergoing refractive
surgery.
Wavefront guided (WFG), or “custom”, refractive surgery has been evaluated by the Naval
Refractive Surgery Center and yielded results that are superior compared to conventional
treatment. Based on this analysis, aviation personnel should undergo a wavefront-guided or
custom procedure, if possible. Some patients are not candidates for a wavefront-guided
treatment for various reasons, and a conventional treatment remains a viable option. As with any
surgical procedure, there are inherent risks, such as quality of vision deficits (e.g. halos and glare
at night) and persistent eye discomfort (e.g. dry eye or recurrent erosions). A detailed
description of the risks, benefits, and alternatives should be discussed and consented between the
patient and their refractive surgeon.
History of PRK or LASIK does not guarantee qualification for an aviation duty waiver. The
member must meet pre-operative standards in MANMED and this waiver policy guide. Postoperatively the applicant must meet all MANMED vision standards appropriate to their aviation
class.
When obtaining corneal refractive surgery it is incumbent upon the member and the member’s
commanding officer and flight surgeon to be aware of corneal refractive surgery waiver
recommendations at the time of the surgery and subsequent submission. Rapidly evolving
technology results in changes to waiver guidelines when appropriate. Every effort will be made
to publish new regulations widely, but the only valid source of current recommendations shall
remain the Manual of the Medical Department. When in doubt, NAMI ophthalmology remains
available for consultation through phone or email:
850-452-2933 ; [email protected]
Medical Codes:
P1177 / H1177 PRK
P1171 / H1171 LASIK
U.S. Navy Aeromedical Reference and Waiver Guide
Ophthalmology - 23
12.15A LASIK IN DESIGNATED AVIATORS STUDY
Class I, Class II: The LASIK Study for designated Class I and Class II personnel has been
closed. Be aware that Class I personnel are required to have their LASIK procedure performed
at one of the DoN Refractive Surgery Centers (including Tripler AMC and Keesler AFB, which
have Navy ophthalmology support). Class II personnel may have LASIK performed at any DoD
refractive surgery center. For designated personnel previously enrolled in the study, annual
submission is required for renewal with supporting documentation per the LASIK study
protocol.
12.15B LASIK IN STUDENT AVIATORS STUDY
AEROMEDICAL CONCERNS: The goals of this study are to evaluate safety, efficacy, and visual
performance of LASIK in student naval aviators, flight officers and aircrew.
WAIVER: At this time, waivers for LASIK in Class I aviation applicant personnel require enrollment in
the LASIK in student aviators study. For more information on study enrollment and inclusion criteria
contact NMCSD Refractive Surgery Center at :
http://www.med.navy.mil/sites/nmcsd/Patients/Pages/RefractiveSurgeryCenter.aspx. For Class II and III
aviation applicant personnel, waivers will be considered without study enrollment.
GENERAL GUIDELINES:
1. Pre-LASIK refractive error measured under cycloplegia must not exceed -8.00 to +3.00 (spherical
equivalent, SE) and 3.00 diopters of cylinder. Anisometropia shall not exceed 3.50 diopters
(using SE for each eye).
2. At least three months have elapsed since surgery or re-treatment and evidence of stable
refractive error.
3. Applicant must have screening vision exam performed at one of 10 participating screening sites:
 NH Bremerton
 NH Camp Pendleton
 NMC San Diego
 WRNMMC (Bethesda, MD)
 NMC Portsmouth
 NH Camp Lejeune
 NH Jacksonville
 BMC Newport
 BMC Annapolis
 NAMI (Pensacola, FL)
Applicant requirements for waiver consideration:
a. Total post-operative higher order RMS aberrations less than or equal to 0.70
microns as measured by a Hartmann-Shack aberrometer, and adjusted for pupil
size per nomogram.
U.S. Navy Aeromedical Reference and Waiver Guide
Ophthalmology - 24
b. Best-corrected mesopic (low-light) visual acuity better than or equal to 0.50
logMAR as measured on a Precision Vision 25% low contrast visual acuity chart.
c. Submission of detailed pre-operative, operative print-outs, and post-operative
LASIK follow-up records.
d. Demonstrate refractive stability.
e. Submission of aviation physical examination (including Standard Form 2808 and
SF507)
f. Free of significant complaints (glare, haloes, starbursts, ghosting, excessive dry
eye syndrome, pain, photophobia, etc.)
g. Not requiring topical ophthalmic medications, aside from occasional artificial tear
use.
h. Have a normal postoperative slit lamp exam, with no visually significant
complications (ectasias, epithelial ingrowth, central scarring, etc.)
i. Meet refractive, cycloplegic, and vision standards post-operatively as defined by
MANMED for aviation class.
j. Annual submission is required for renewal with supporting documentation per the
LASIK study protocol.
Discussion: “All-laser” LASIK is preferred, which utilizes two types of lasers to create the
LASIK flap and perform the vision correction. The laser is preferred over a metal keratome
blade to reduce the risk of operative complications and enhance post-op stability. “Wavefrontguided” or “custom” LASIK is also preferable, if available and the patient is a candidate for
such. “All-laser, custom LASIK” gives a better visual outcome over conventional treatments.
This has been borne out by repeated Navy research studies. Please note that no specific method
of LASIK is mandatory for waiver consideration, as long as all pre- and post-op study criterion
are met.
Medical Codes:
P1171 / H1171 LASIK
U.S. Navy Aeromedical Reference and Waiver Guide
Ophthalmology - 25
Articl e 15-34
Physical Examinations and Standards
keratect omy (common ly known as P RK) , laser
e pithe li a l kerat omil eu si s (commo n ly kn o w n as
LAS EK) and lase r-ass isted in-situ kerat orn ilcusis
(co m mon ly kno w as LASlK) is disqualifying ir illlY
of the followin g co nd itions arc met:
ill Pre- surg ical re fract ive erro r in ei the r
eye exceeds th e sta ndards for the prog ra m sought
(i.e., +/- 8.00 diop ters for enli stm ent and commi ssion ,
+/- ti OO diopters for program leading to a commi s­
sio n) .
ill Less than 6 mont hs has passed since
th last refra c ti ve or aug men t ing procedure and the
time o f the ev alu ation.
ill T he re is
currently a co ntinuing need
to op htha lmic med icati on s o r treatment.
(1} Post -su rgi ca l refract ion in each eye is
not considere d stable as dem onstrated by tw o sepa­
rat e re fractio ns obtaine d at least 1 month ap a rt
diffe ri ng by m o re than +/-0.5 0 diopte rs for spherica l
co rrec tio n an d/ or mor e th an +/-0 .2 5 di opters fo r
cy lin der correc tion .
ill Po st-surgical refraction in each eye
has not been me asu red at lea st one time 3 m onth s or
longe r after th e mo st recent refract ive o r au gm enting
proced ure .
(c) C urre nt keratitis (370) (ac ute or ch ron ic),
including but not limited to re current corneal ulcers,
ero sio ns (abras ions) , or herp eti c ulcer s (05 4 .42) is
disqua lifying .
(d) Cu rrent corneal vas cular iz ation (370.6)
or co mca l opacifi cation (371) from any cause th at is
prog res sive or re duc es vision below the stand ards
prescri bed in article 15-34 is disqu ali fyin g .
(e) C ur rent o r hi stor y of uve it is or ir id o­
cyc lit is . (364 .3) is dis qua lifying .
(4) Retina
(a) Current o r hi stor y of retin al de fec ts an d
dystro phies , ang iom atoses (759 .6), reti noschis is an d
retinal cysts (36 1. 1), phakornas (362.8 9) , and other
co ngc n ito-re tinal her editary co ndi tio ns (362 .7) tha t
impair vi sua l fu nc tio n, or a re prog ressive is di s­
qua lify ing.
12 A ug 2005
( b) Cu rrent or histo ry of any choriorc tinal o r
ret inal infl am mat o ry co nd ition s , includ ing bu t not
limited to conditio ns leadi ng to nco vas c ularization,
chori o retin itis, histoplasmo si s , tox op lasmosis , o r
vascula r cond ition s of th e eye (to in cl ude Coats '
Disease and Ea les' Di sease) (363) is disqualifyi ng.
(c) Curren t or hist ory of deg enera tive changes
of an y part o f the retina (36 2) is disqua lifyi ng .
(d) C ur rent or his to ry of de tac hment of the
retina (36 1), histo ry of surgery for sa me, or pe ripheral
retinal inju ry, de fect (36 1.3) or dege nera tion tha t may
ca use ret inal detac hment is d isqu a lifying.
(5 ) Optic Nerve
(a) Current o r history of o ptic neuritis (377 .3)
is disqua lifyi ng , inc ludi ng but not lim ited to neuro­
retiniti s, se con dar y optic atrophy, or documen ted
hi story of ret ro bulbar neuriti s .
(b) Current or history of opt ic atrop hy (3 77 . 1)
or co rtica l blindness (377 .75) is di squa li fyin g .
(c) Current or history of pap illedema (377.0)
is dis qualify ing .
(6) Lens
(a) Curren t ap ha kia (379 .31), histo ry o f len s
im p lant, or curre nt or history of di slocation of a lens
is disqualify ing.
(b) Cu rre nt or histo ry of opaci ties of the lens
(366) that inte rfe re wi th vision or that are co ns idered
to be pro g ress ive , including ca taract (366. 9) are d is­
qua lify ing .
(7) Ocular Mobility and Motility
(a) Curren t dipl opi a (368 .2) is disquali fyi ng .
(b) Cu rren t nys tagmus (379. 50) oth er than
ph ysiologic "end -p oi nt nystagmu s" is dis qualifying .
(e) Esot ropia (378 .0) an d h yp ertrop ia
(378 .3 1): Fo r e ntra nce int o Se rv ice aca de m ics and
officer prog ram s, addi tiona l requ irem ents may be set
by the individual Military Services. Special admini s­
trati ve crite ria for assig nm e nt to ce rta in specialties
shall be de te rmined by the Mi lit ary Serv ices .
Change 126
15-27
ENCLOSURE (
4)
Manual of the Medical Department
Article 15-34
ill 20/40 in o ne eye and 20170 in the other
(R) Mlscellun eous Defects and Diseases
(a) C urrent o r hist o ry of abnorma l vis ua l
fie lds due to di sea ses o f th e eye o r cen tral ner vou s
sys tem (368.4) , or trauma (368. 9) is Ui squ a lify ing .
(b) Absen ce of an eye , c linica l ano phthal mos,
(u nspeci fied cong en ital (74:\ .00) o r ac q uired) or cur­
rent or his tory o f other disorders of g lobe (360.8) is
di squ alifying .
(c) C urre n t a st he no p ia (368 . 13) is d is­
qua lifyi ng.
(d) Curren t unilateral or bilateral non-famili al
exo phtha lmos (376) is d isq ua lify ing .
(e) Cu rr ent or history of g la uco m a (365),
including but no t limited to primary, secondary, pre­
g lauco ma as evidence d by intraocul ar pressure ab o ve
2 1 mmHg, or ch anges in the optic disc o r vis ua l field
loss associate d w ith glaucoma is disqu alifying .
( f) C urrent loss of normal pup illary refl ex,
react ions to accommodation (367 .5) or light (37 9.4),
in clu ding Ad ie 's Sy ndro me is disqu al ifying .
(g) Cu rr e nt night b li nd n ess (3 6 8 .6 0 )
disq uali fyi ng.
eye .
ill 20/30 in
O IlC
eye a nd 20/100 in thc
other ey e .
ill
20/ 20 in one eye and 20 /400 ill thc
othcr eye,
(b) Current ne ar vis ua l acuit y o f any degr ee
tha t doe s not co rrect to 20 /4 0 in th e bette r eye (367)
is di squ alify ing .
(c ) C u rr en t rcfrac ti v e e rror [hyp erop ia
(367. 0), myo pi a (367 .1 ), as tig matism (367 .2)] or
histo ry of re fracti ve e rro r pr ior to any re frac tive
surge ry manifest by a ny refracti ve erro r in sphe rica l
eq uiva lent of worse th an -8.00 or +8 .00 diopter s is
d isqualifying .
( d) Cur re nt co mp lic a te d ca se s requ irin g
co ntact len ses for adequate correct ion of vision, such
as corn eal sca rs (371 ) an d irregu lar astigm at ism
(367 .2) are disq ua lifyi ng .
IS
15-36
I
(h) C urrent or hist or y o f retain ed intraocul ar
forei gn body (36 0) is di squ alifying.
(i) Cu rrent or history o f an y orga nic di sease
of the cye (:\60) o r ad nexa (376) , not s pec ifie d in
artic le 15-31 ( 1) throu gh 15-31 (8)( a) th rough 15-3 I
(8)( 11) abo ve, wh ich th reatens vision or visua l func­
tion is di squal ifying.
Vision-Commission
and Programs
Leading to a Commission
The standards for enlistment, commi ssio n, and en try
into a pro gr am leading to a co mm iss ion are different;
refer to the ap pro priate section.
( 1) For comm ission ill the N Ul')' Un restricted
Lin e and/or co mm is sio n of o ffic e rs w ith int e nd ed
-
15-3
Vision-Enlistment
Th e standa rds for e nlistment, commi ss ion, a nd e ntry
into a program leadi ng to a co mmission are different ;
refer to the appropriate sect ion .
( I) For Enlistment
(a) Current distant visua l acuit y o f any degree
that docs not correc t wi th spectac le lenses to at least
one of the fo lll)w ing (36 7) is di squ al ifyin g :
15-28
designators o f 6 11x, 6 12x , 6 16x, 62 1x , 622x, 626x ,
648 x, 7 11 x, 7 12x, 7l 7x, 721x, 72 2x, 727x, 748x:
(a) Curre nt dist ant o r near vis ual ac uity of
a ny degree that does not co rrec t with spectac le len ses
to 20/20 in each eye is disqu al ifyin g .
(b) C u rre nt rcfrac ti vc error [h yperop ia
(367 .0) , myo p ia (367 . 1), astig m at ism (:\67 .2) ] or
history of refractive e rror pr ior to an y refract ive
sur gery man ifest by any refra ctive err or in spheri cal
eq uiva lent of wo rse than - ~ . O O or +8 .00 d iopters is
disqua lifyi ng.
Change 126
12 Aug 2005
ENCLOSURE ( q)
A rtic le 15-36
Phy sical Examinations and Standards
(c) Cu rre nt com plica ted cases req ui ri ng co n­
tact le nses fo r adeq ua te co rrec tion of v ision, s uc h as
corneal sca rs (371 ) an d irre gul ar astigma tis m (367 .2)
arc disq ualifyin g .
(d) Lac k of ade q uate Co lo r Vis io n is di s­
qualify ing . Adeq uat e color visio n is dem onstrated
by:
ill Co rrec tly ide ntifyi ng
12, 13, or 14 ou t
of 14 Pse udo-Iso ch romatic Plates (PIP) . A pplica nts
failing the P IP s ho uld be tested via the Fa rns wort h
Lan tern (FA LANT ) as descr ibed be low .
ill Pa ssi ng the FALANT test. A passing
FALANT sc o re is obta ined by co rrectly identifying
9 out of9 pr esentat ion s o n the first test se ries . If a ny
incorrect ide ntifica tio ns are made, a second co nsec u­
tive series of 18 pre sentations is admini st ered. On
the second seri es, a pass ing score is obta ine d by
co rrec tly identifyin g 16, 17, o r 18 pre sentati on s.
(2) For Entry into a Program Leading to a
Commission in the Navy Unrestricted Line
(a) Cu rrent d istant and near vis ual acuity of
any de gree that do es not correct with sp ectacle lenses
to 20/20 in eac h eye is di squ aJifyi ng .
(b) Current s phe rica l refractive e rror [hyper­
opia (367. 0), my op ia (367.1)] or history of spherical
refrac tive e rro r pr ior to an y refractive surg e ry o f
worse than -6.00 o r +6.00 diopt er s is di squalifyi ng .
(c) Curre nt c ylinde r re fractive e rror [asti g­
matism (367 .2)] o r history of cy linde r refractive er ror ,
prior to a ny refra cti ve s urgery, o f wo rse than -3.00
or +3.0 0 di opters is di squali fyin g.
(d) C urre nt com p licated cas es req uiring co n­
tact len ses for adeq ua te co rrec tio n of vi sion , suc h as
corneal sca rs (371 ) and irre gul ar astigma tism (36 7.2)
arc disqu alifying .
(e) Lac k o f ade q ua te Co lo r Visio n is d is­
q ua lify ing . Ad equat e color vi sion is de mon strate d
by:
ill C orrectly identifyin g
12,1 3, o r 14 ou t
of 14 PIP. Applicant s failing the PIPshould be test ed
via the FA LA NT as described be lo w.
12 Au g 2005
ill Passin g th e FAL A NT test. A pa ssi ng
FALANT sco re is o bta ine d by correc tly id e ntify ing
9 o ut o f 9 presentation s o n the first test series . l f any
i ncorrect ide ntificati on s are made, a sec on d co ns ec u­
tivc se ries of I ~ prese ntati on s is ad m inistered . O n
t he se con d se ries a pa ss ing score is obta in ed by
correctly identifyin g 16, 17, or 18 presentati on s.
(3) For Commission in the NfII~v Restricted Line,
Staff Corps, an d desi g nators not in cluded in articl e
15-37(3) above.
(a) C urre nt d ist ant o r nea r vis ua l ac uity o f
any degree that does not co rrect wi th spectac le lenses
to 20/20 in eac h eye is d isqualifyin g .
( b) C u rre n t refra cti ve e rro r [hy p eropi a
(36 7.0), myopia (36 7 .1), astigmati sm (367 .2)J, or
history of refractive er ro r, prior to any refrac tive s ur­
gery mani fest by an y refra cti ve e rro r in s phe rica l
eq uivale nt of wo rse than -8.00 o r +8 .00 di opters is
di squalifying.
(c) C u rre nt co m p lic a ted e as e s requiring
co ntact len ses fo r ad equ ate co rrec tio n of v isio n, s uc h
as co rn eal scars (371 ) and irr egular asti gmatism
(367. 2) are di squalifying .
(4) For Commissio n in the United States Murine
Corps
(a) C urre nt di stant and near vis ual acu ity o f
a ny degr ee that does no t corr ec t with spectacle len se s
to 20/20 in eac h eye is di squalifying.
( b) C urr e nt re f racti ve e rro r [h yp ero p ia
(367 .0), myop ia (367.1), asti g mati sm (367.2)J, or
history of refractive error prior to a ny refracti ve sur­
gery manifest by an y refractive erro r in sph eri cal
eq uivale nt o f wo rse th an -8 .00 o r t-X.OO di o pters is
disqu al ify ing.
(c ) Curre nt co m p lic a te d cas es req u mn g
co ntac t len ses fo r adequate correc tio n of vis io n, suc h
as co rn ea l scars (3 71) a nd irreg ula r astigm at ism
(367 .2) arc disqu alifying .
(5) For Entry into a Program Leading to a Com­
mission in the United Stat es Marine C{)Ip S
(a) Curre nt dist a nt o r nea r vi sua l acu ity o f
any deg ree that does not co rrec t with spectacle len ses
to 20/20 in eac h e ye IS disqual ifyin g .
Change 126
15-29
ENCLOSURE ( "l )
Article 15-102
Physical Exa minations and Standards
ill Ma x illo fac ia l or c raniofa cia l ab no r­
ma litie s p rccl u ding th e comfo rt able use of diving
headg ea r in cluding headgear, mo uthp iece, or
regula tor is di sq ua li fying .
ill
Hea ring in the be tte r ea r mu st m e e t
standard s for initia l accepta nce fo r activ e duty. Whi Ie
not d isqua li fying fo r di v ing duty, unilateral h ig h­
freq uency hearing lo ss s ho u ld re cei ve appropriate
otol ogy e valua tion an d su rve illa nce moni tori ng .
ill De signated
dive rs with fu ll rec o ve ry
from ei the r tympanic membran e pe rfo ra tion or ac ute
sinusit is m ay be re inst at ed a t th e d iscr et io n of the
UMO.
(c) Eyes and Vision
ill
S po nta ne o us pneum othorax is d is­
qua lifyin g.
ill T raumati c pneumothora x (othe r th an
that caused by a di v ing -r elated pu lmo na ry baro ­
tra uma) is disq ua hfying . A wa ive r req ues t will be
co nside red for a candida te o r d e s ig nat e d di ver afte r
a period of at lea st 6 mo nth s an d mus t include :
W N o rm al
pulmon a ry f u.icti o n test­
ing.
ilil Standard,
W
non-contras t chest CT.
Favorab le reco m m e nd ation from
a pul m on ol ogist.
ill A ll D iv e rs must hav e a m in im um
correcte d v is ua l ac u ity of 20/25 in o ne e ye .
ill Minimum unco rrec te d visual ac uity :
W DMO , basic diving office r, se lf
co ntai ned u nd e rsea breath ing appara tus (SC UBA)
d ive rs , hyp e rba ric ex posure no n- dive r q ua lified : +1­
8 .00 diopt er s .
ilil Se co nd C la ss d iver , N a vy H o spi ­
tal C o rp sm a n (NEC 8403-8427) assig ned to d iv ing
duty, Army 21 se ries, Army or Air Force s pe c ia l
ope ra tio ns : 20/2 0 in ea ch eye .
ill Hi sto ry of refract ive co rn eal surg ery
is no t co ns ide red disqua lifyi ng . Ho we ver, candida tes
mus t wait 3 mo nths fo llowing th eir mo st re ce nt s u r­
gery ( P RK o r L A S IK ), have sa tis fac tory im p ro ve­
me nt in vi su al ac uity, an d be fu lly re co ver ed from
any surg ica l procedure. A des ignated d ive r mu st wa it
I mo nth p o st- LA S IKlP RK a nd be fully recove red
from a n y s urgi ca l p ro c e d u re w it h sa tisfac to ry
imp rove m ent in the ir v is ua l ac ui ty pri o r to resu m p­
tion of div ing.
(1l Orthokerato logy las ting 6 mo n ths
aft er ce ssation of ha rd c o ntac t lens w e ar is dis­
qua !i fying.
ill Lac k of adequ ate color visio n is dis ­
qu alifying . Se e a rt ic le 15-36 ( I )(d) . Wai ve rs wi ll be
cons id e red on a ca se -by-c ase ba s is
12 Aug 2005
(d) Pulmonary
(ill Fi nal eva lua tio n and approva l by
attending U MO .
ill Chron ic obstru ctive or restr ic tive p ul­
mon ary dis ease is di sq ual ifyi ng .
ill Candidate s a nd d e s ign ate d d iv e rs
un d e rg o i ng dru g th er ap y fo r a p os iti ve p uri ti e d
protein derivative (PPD) m ust complete a full course
of INH therapy pri or to th e st a rt of d iv er train ing or
reinst a te m en t to di v ing d uty .
ill
Di vin g- re la te d p u lmo na ry ba ro­
trauma :
ill Desig nated divers who experi ence
m edi a stinal o r su bcu ta neo us e m p hy se ma fo llowing
a viola tion of procedu re a re I PQ for diving duty fo r
I month . T hey may be returne d to di v ing duty foll o w­
ing compl eti on of th e w aive r pr oc e ss via BUM E D
to N AVPERS, if the div er is asymptoma tic and is
de te rmi ned to have a no rm al , sta nd ard , non-cont rast
chest CT.
(b) A histo ry of p ul m on ar y ba ro­
traum a in a d iver ca n d id a te is d isqualifying .
Designated divers w ho expe rience a pulmonary baro­
tra uma follo w ing a di ve with no procedu ral violat ion s
or a se cond epis ode of p ul mona ry barotr a um a, ar e
co ns idered disq ua lified fo r d ivi ng duty. A waiver
requ est w ill be co nside red if the di ver is asympto­
ma tic a fte r I mon th and must inc lu de :
Change 126
15-75
ENCLOSURE( ,0 )