Police officer applicant with recent implantable phakic lens for myopia

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docrja

Police officer applicant with recent implantable phakic lens for myopia

Post by docrja » Thu Mar 10, 2016 11:16 am

Colleagues:

Any experience with municipal armed police officer applicants who underwent this operation for high myopia?
I have the operative report dated 1/6/16 and 2 follow up examination progress notes and the ophthalmologist has charted no problems and that his next follow up examination is due in " 3 months". He and the Employer are pushing to start him right away, and our police cadets once on board are armed and must be ready full duty immediately once they pass the medical exam. (So far his medical status is Defer, or incomplete, on my end as the Government doctor).

I believe that he should wait until at least 6 months to monitor for complications or need for additional procedures.

Any thoughts?

Thank you



Robert Swotinsky MD
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Re: Police officer applicant with recent implantable phakic lens for myopia

Post by Robert Swotinsky MD » Mon Mar 14, 2016 9:03 pm

This is from the ACOEM Guidance for the Medical Evaluation of Law Enforcement Officers (LEOs):
4.5.6 – REFRACTIVE SURGERY
Refractive surgery can be a reasonable option for LEOs with refractive error. For LEOs who undergo refractive surgery to correct refractive error, the operating surgeon should complete the surgical report form (see Appendix A), describing the surgery and post‐operative course. This form will provide sufficient information to the police physician to enable evaluation of the LEO for duty status. For unrestricted duty, the LEO should be
free of:

 significant haze (+2 or less is acceptable);
 glare, halos, starbursts, and ghosting (monocular diplopia);
 microstriae that affect vision;
 dryness that affects vision;
 loose epithelium, diffuse lamellar keratitis (DLK), and/or active infection;
 present a stable refraction (no more than ½ diopter of change between documented refractions at least  2 weeks apart); and
 not be using steroid eye drops.

* * * * *
* * * * *

Regression of surgical effect can occur with patients with high degrees of pre‐operative refractive error (greater than 7 diopters). These LEOs should have an annual refraction to assess for possible visual acuity deterioration.
The reader may subscribe to this guidance document on the ACOEM website and get a full copy of the vision (and other standards), including the above-referenced Appendix A. BTW, the term "refractive surgery" refers to a surgical procedure for correcting or improving vision. Insertion of a phakic lens is a type of refractive surgery.

Daveinfo123

Re: Police officer applicant with recent implantable phakic lens for myopia

Post by Daveinfo123 » Tue May 31, 2016 2:27 pm

I am a co-author of the ACOEM vision chapter. I did not go into great detail about Phakik Intra ocular lenses (PILOLs). Cataract formation (acutely) is an issue with PIOLs. Note, the California Peace Officer and training standards suggest that 1) incisions need to be well healed 2) refractive error is stable and 3) "cataracts are unlikely over a 12 month period" -- I assume this means wait 12 months -- but since 70% of the cataracts occur in the first three months, I think you have to wait at least that long (3, if not 12 months.)

docrja

Re: Police officer applicant with recent implantable phakic lens for myopia

Post by docrja » Tue Jun 14, 2016 2:26 pm

Noted Dr. Dave and Dr. Swotinsky.

I very much appreciate your responses. I waited until month 6 and verified all these items in his internal optometry/ophthalmology reports at 6 months plus then qualified him.



Thank you again!
docrja
CDL Examiner and Occupational Medical Examiner for Large Municipal City Employer/Airport

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