Visual and flight performance recovery after PRK or LASIK in helicopter pilots

INTRODUCTION: Refractive surgery, specifically photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK), is becoming more accepted in the military environment. Determination of the impact on visual performance in the more demanding aviation environment was the impetus for this study. METHODS: A prospective evaluation of 20 Black Hawk pilots pre-surgically and at 1 wk, 1 mo, and 6 mo postsurgery was conducted to assess both PRK and LASIK visual and flight performance outcomes on the return of aviators to duty. RESULTS: Of 20 pilots, 19 returned to flight status at 1 mo after surgery; 1 PRK subject was delayed due to corneal haze and subjective visual symptoms. Improvements were seen under simulator night and night vision goggle flight after LASIK; no significant changes in flight performance were measured in the aircraft. Results indicated a significantly faster recovery of all visual performance outcomes 1 wk after LASIK vs. PRK, with no difference between procedures at 1 and 6 mo. Low contrast acuity and contrast sensitivity only weakly correlated to flight performance in the early post-operative period. DISCUSSION: Overall flight performance assessed in this study after PRK and LASIK was stable or improved from baseline, indicating a resilience of performance despite measured decrements in visual performance, especially in PRK. More visually demanding flight tasks may be impacted by subtle changes in visual performance. Contrast tests are more sensitive to the effects of refractive surgical intervention and may prove to be a better indicator of visual recovery for return to flight status.