1.4. PresbyLASIK •The technique •The technique Contrary to the previous technique, the patient’s lens is The PresbyLASIK is a technique derived from the LASIK conserved. The lens, according to its design, is placed method that is specifically for laser correction of pres- behind the iris (pre-crystalline phakic implant) or is byopia. The technique itself is the same as for LASIK. attached to its anterior side (iris fixated). This surgery is The difference comes from the profile of photoablation reversible, as the lens can be removed. by the Excimer laser. •Recovery time and side effects Nearly all existing treatment platforms offer a laser Patients may feel eye irritation after surgery. treatment solution for presbyopia. The goal is to create Functional improvement is noticeable on the day of a multifocality on one or both eyes as well as a mini surgery and often at its best in the first week. This monovision by playing with the ocular dominance to intervention requires annual monitoring of the density increase depth of field and to encourage optical aber- of endothelial corneal cells and the transparency of the rations that facilitate near vision. Monovision works13 crystalline lens that may in some cases become hazy or by correcting one eye for emmetropia (distance) and a cataract. the other eye for myopia (near vision). •Recovery time and side effects •Specific complications The definitive functional recovery is longer than after a Complications are rare,common to all intraocular LASIK not correcting presbyopia.Halos and loss of surgery and primarily: endophthalmitis, retinal contrast perception are also more common. The mono- detachment and anteriorchamber inflammation. vision created by the surgery can degrade stereoscopic Specific complications of this surgery are infrequent but can be short and long term: elevated intraocular vision. pressures from pupillary block, endothelial cell 2. Intraocular refractive surgery damage that can lead to corneal decompensation, corectopia or cataract. Intraocular refractive surgery makes it possible to cor- rect spherical and cylindrical refractive errors by adding MILITARY PARACHUTING QUALIFICATION an intraocular lens. PRELEX (PREsbyopic Lens STANDARDS IN THE FRENCH ARMED FORCES EXchange), also called lens replacement surgery or clear lens extraction, may be a better option than LASIK AFTER REFRACTIVE SURGERY or PRK for people with presbyopia. Assignment of the medical fitness after such a surgery 2.1. Presbyopic Lens Exchange depends on: •The technique - the degree of initial ametropia that should not be Like cataract surgery, clear lens extraction uses the prin- over eight dioptres; ciple of phakoemulsification to remove the lens and to - the axial length of the eyeball that cannot be over replace it with a posterior chamber intraocular lens .14 26mm; This lens allows far sight, medium and near sight to be - the type of surgery carried out; corrected. This surgical intervention may be offered to - the delay since the operation; subjects over 55 years of age. - the anatomical and functional results and the position of the interested party in terms of the institution. •Recovery time and side effects Postoperative effects are similar to cataract surgery. PRK, LASIK and ablation of a corneal stroma lenticule Patients may feel eye irritation, without associated are tolerated. Any other corneal or intraocular refrac- pain. Visual acuity is improved from the day after sur- tive surgery will trigger unfitness to serve. gery up to a week after in general. Due to the multifo- cality of the intraocular implant, patients may have 1. Initial medical fitness for static line parachute photophobia, halos or reduced contrast perception. jumps •Specific complications In the initial examination: Complications are rare and are common to all intraocu- - visual acuity, without correction, should be equal or lar surgery, mainly: endophthalmitis, posterior capsular over 3/10 for each eye or 4/10 and 2/10 or 5/10 and 1/10; rupture, retinal detachment, macular oedema… - visual acuity, with correction, must be equal or over 8/10 for each eye or 7/10 and 9/10 or 10/10 and 6/10; 2.2. Phakic intraocular lens implantation - the degree of ametropia must not be over -3 or +3 This surgery can be offered to patients who have a dioptres; contra-indication to corneal refractive surgery by laser, - errors reading the Ishihara pseudoisochromatic linked to excessive ametropia or a cornea that is too plates are tolerated without outright confusion bet- thin or at risk of ectasia. ween green and red lights; - the horizontal binocular visual field, made by In comparison with corneal surgey, g-oder optical confrontation using a finger, should not be less than VOL. aberrations are minimised, and the refractive results 140° and/or the vertical visual field less than 60°; 94/3 are often very satisfactory with good predictability.15 depth-perception (TNO test) must be satisfactory. - International Review of the Armed Forces Medical Services 44 Revue Internationale des Services de Santé des Forces Armées