21 April 2008
To Whom It May Concern:
I am a military physician currently serving in a Troop Medical Clinic in Iraq, where I take care of sick and wounded soldiers and marines. Although I have been an Active Duty member of the Army during the entire period of Operation Iraqi Freedom, and have volunteered for combat zone duties throughout that time, this is my first deployment. Prior to this time, I have been medically unable to deploy, due to severe dry eye syndrome which was brought on by LASIK surgery.
In 2003, I was offered LASIK at Walter Reed Army Medical Center. This procedure was touted as a painless and extremely safe outpatient surgery, which would serve not only to improve my vision, but would also increase my readiness to serve in combat, by reducing my dependence upon glasses and contacts. Unfortunately, it has not turned out this way for me. My surgery was in July of 2003; I had a serious complication, diffuse lamellar keratosis (DLK), which resulted in a need for a second surgery by a civilian provider who specializes in LASIK complications. Thankfully, after successive eye surgeries, I regained most of my vision (though I still require prescription glasses); however, the sterile inflammation of DLK resulted in the loss of most of my basal lacrimal glands, as evidenced by a Schirmer test score which declined from 10-plus pre-op, to immeasurably small post-op. Loss of tear gland function resulted in great physical discomfort, as well as a number of corneal abrasions.
Throughout 2004 and 2005, with the invaluable help of the Army, I tried many treatments for dry eye, ranging from innumerable types of artificial tears, fitting of scleral lenses by the outstanding Boston Foundation For Sight, cyclosporine eyedrops, and the use of Panoptyx moisture chamber goggles. It was this latter device which finally enabled me to reclaim some of my life, and to get through the day with less pain, and a decreased risk of corneal abrasions. While I am not overjoyed at having to wear “spaceman” goggles much of the time, I am very grateful for them, as they have indeed enabled me to resume my career as a Hematologist-Oncologist at Eisenhower Army Medical Center at Fort Gordon, GA, and to serve my country overseas, as I am doing now. I have also been fortunate to have some modest regain in the function of my lacrimal glands, which I attribute to the use of cyclosporine over the past three years
In 2007, after a thorough evaluation by CPT Gary Fillmore, as military ophthalmologist who has been of great help to me throughout this process, my non-deployable status was revoked, and I was allowed to serve a six-month deployment in Iraq. I have had some difficult days here due to the unforgiving environment, but thanks to my Panoptyx goggles, a steady eyedrop regimen, and CPT Joshua Baker, an excellent optometrist with whom I share my current facility, I am surviving.
As a physician, I have quite frequently seen the under-reported decline in lacrimal gland function in the soldiers, sailors, airmen, and marines who have come under my care. Dry eye is especially an issue in the arid, dusty environments of the Middle East. I currently have two medics in my clinic who had LASIK surgery, and both of them have significantly reduced tear function, and have therefore struggled in this environment, requiring medical interventions beyond simple eyedrops. I strongly believe that the loss of tear function which is deemed an “acceptable” downside to LASIK surgery, is in fact not at all acceptable for many people who lead an active lifestyle with exposure to extremes of heat and cold, sandy or dusty environments, and/or wind. It seems to me that it would be prudent for the FDA to require more extensive evaluation of post-LASIK dry eye syndrome and its clinical sequelae than is currently being done. I know from my own experience and that of many patients with whom I have come into contact that this can be a devastating complication of an elective surgery.
Thank you for your time.
Erik J. Rupard, MD
MAJ, MC, USA
Medical Officer In Charge
Troop Medical Clinic
Al Asad FOB, Iraq
The opinions of the author expressed herein do not necessarily state or reflect those of the United States Government, the United States Army, or the Department of Defense.