MILITARY MEDICINE, 179, 1:76, 2014 Refractive Surgery Policy and Its Effect on Visual Acuity Qualification Rates for the 2004 and 2011 Army ROTC Flight Applicant Pools LTC Scott F. McClellan, MC USA*; COL James S. McGhee, MC USA (Ret)†; MAJ John H. Boden, MC USA*; LTC Robert W. Davis, MC USA*; MAJ Paula E. Young, MC USA*; COL Mark F. Torres, MC USA* ABSTRACT Objectives: The goal of this study was to ascertain the effect of recent U.S. Army Aviation corneal refractive surgery (CRS) policy changes on the size of flight school applicant pools by comparing statistics from the 2004 and 2011 Warrior Forge Army Reserve Officers’ Training Corps training camps. Methods: A retrospective chart review was performed using the United States Army Aeromedical Activity’s Aeromedical Electronic Resource Online database. Results: Of the 607 applicants from 2004, 100 (16%) were disqualified for decreased visual acuity and had refractive errors correctable by CRS. Thirty-four cadets (6%) had prior CRS, and 21 qualified for flight school in 2004. Of the 625 applicants from 2011, 105 (17%) were disqualified for decreased visual acuity and had correctable refractive errors. Sixty-four applicants (10%) had prior CRS, and 54 subsequently qualified in 2011. Conclusions: Changes to Army Aviation CRS policy over the last decade have been associated with an increased number of initial flight applicants who now meet visual acuity standards. However, only a small percentage is using this resource. Army Aviation has the potential to significantly widen its applicant pool if more candidates are made aware of accepted CRS techniques that can help them to meet rigorous vision standards. INTRODUCTION United States Army flight school applicants must meet rigor- ous physical standards to become medically eligible for flight school. Decreased uncorrected visual acuity (i.e., distance/ near uncorrected visual acuity and cycloplegic refraction) is the most common reason initial applicants fail their class IA (officer) and class IW (warrant officer) flying duty medical examinations (FDMEs). 1 Stringent standards are warranted because decreased visual acuity degrades a pilot’s stereopsis, scanning ability, and target acquisition. 2 All these factors are important for optimal visual performance and success- ful mission outcomes in demanding garrison and deployed aviation operations. The U.S. Army Aeromedical Activity (USAAMA) located at Fort Rucker, Alabama, has the responsibility of reviewing all initial FDMEs to determine whether personnel are medi- cally qualified for flight duties. An “Exception to Policy” (ETP) may be considered for initial applicants whose medical conditions do not meet current aeromedical standards. These recommendations are then sent by USAAMA to the U.S. Army Human Resource Command (HRC) located at Fort Knox, Kentucky, for final approval. Initial flight applicants are medically disqualified from flight school if their uncorrected visual acuity is worse than 20/50 for distance and 20/20-1 for near vision (i.e., missing one letter on the 20/20 line of the Snellen Visual Acuity chart at 14 inches, 16 inches, or 40 cm depending on the test used for near vision). 2 Uncorrected distance visual acuity of up to 20/70 and near visual acuity of up to 20/40, however, will generally be considered favorably for an ETP in otherwise qualified applicants on a case-by-case basis. In addition, USAAMA has established cycloplegic refraction standards that range between -1.50 diopters (D) of myopia (e.g., near- sightedness) and +3.00 D of hyperopia (e.g., farsightedness) with astigmatic (e.g., cylinder) corrections between -1.00 D and +1.00 D. 2 Similar to visual acuity standards, ETPs are routinely granted for cycloplegic refractions that, after three independent measurements by an optometrist or an ophthalmol- ogist, minimally exceed these standards (i.e., within 0.75 D) based on the needs of the Army. 2 According to Army Regulation 40-501, paragraph 4-11c, an aviation applicant is considered disqualified for flight duties if he or she has a history of ocular surgery, including corneal refractive surgery (CRS). 3 Before 2001, initial flight applicants with prior CRS were automatically disqualified from entering flight school. Owing in part to the safety and efficacy shown in a series of military CRS studies, most notably a landmark 1993 study of U.S. Navy special opera- tions forces 4 and a decreasing applicant to flight training position ratio from a historical rate of 3:1 to 1.3:1, 5 a longi- tudinal pilot study was initiated by the U.S. Army Aeromed- ical Research Laboratory at Fort Rucker in February 2001, *Ophthalmology Department, Madigan Army Medical Center, 9040A Fitzsimmons Drive, Tacoma, WA 98431. †United States Army Aeromedical Activity, 110 Shamrock Avenue, Fort Rucker, AL 36362. The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-13-00260 MILITARY MEDICINE, Vol. 179, January 2014 76 Downloaded from https://academic.oup.com/milmed/article-abstract/179/1/76/4160707 by guest on 25 May 2020