Radial keratotomy in the soldier-aviator

Radial keratotomy (RK) is an ophthalmological procedure that alters the shape of the cornea, making it "flatter," causing the desired shift to farsightedness. Complications can be minor and "normal" in the immediate post-operative period, or can include problems that occur in many eyes, that persist but do not decrease best corrected visual acuity, or may include events that potentially or actually threaten vision and may produce blindness. At best, only 50% of patients can expect to have 20/20 uncorrected vision 2-3 years after surgery. Diurnal fluctuations in vision (two-five Snellen lines) can persist years after RK. Perhaps 1% of patients may have a two-three Snellen line loss of best corrected vision or ghost images that interfere with clear vision. Disabling glare can disrupt daily activities. Eyes that have undergone RK are at increased risk of corneal rupture after blunt eye trauma. The visual demands of the active duty military, and more dramatically the military aviator, are incompatible with RK. Therefore, RK should not be performed on active duty soldiers, nor should enlistees be accepted if they have undergone the procedure.