Concerning refractive surgery, all surgery from less than operated on with refractive surgery are able to para- six months before or any surgery done before the age chute if the operationalinstructions are respected. It of 20 and up to 21, is a cause of unfitness. should however be kept in mind that the lesions to the retinal periphery that are often found in subjects with In initial medical examinations carried out in the myopia can be a cause of unfitness due to the major context of a recruitment in the armed forces such as in risk of retinal detachment. examinations in the course of a career, a specialised opinion is systematically looked for. The ophthalmological assessment in an examination for fitness after refractive surgery systematically 2. Initial medical fitness for delayed opening includes a corneal topography, but other examinations parachute jump may be carried out (glare test, contrast sensitivity, aber- rometry, etc.) to evaluate the functional results. The constraints of the environment,particularly at very The applicant must meet the conditions for initial high altitudes (low hygrometry and relative wind), may medical fitness for static line jumps and night vision however accentuate the side-effects linked to surgery, must be normal. particularly ocular dryness. 3. Initial medical fitness for operational jumps at In case of a myopic subject allowed to parachute high and very high altitudes and for tandem pilot before refractive surgery, the return to jumps may be envisaged 1 month after the operation if the anatomi- Visual acuity should be equal at least 16/20 without cor- cal and functional result is considered satisfactory by a rection for both eyes (either 8/10 and 8/10 or 9/10 and specialist. 7/10 or 10/10 and 6/10).The visualfield should not Phakic lens fitted in subjects with high ametropia that show anomalies. is well over the standards are a cause of unfitness for The applicant must also meet initial medical fitness military paratrooper. The multifocality (multifocal lens, conditions for static line jumps and night vision must be Extended Depth of Focus lens or presby-LASIK) is a normal. cause of unfitness for parachuting due to major halos and poor quality of vision. The correction of presbyo- 4. Medical fitness for experimental parachutist pia using monovision (non dominant eye remains myo- pic) is also a cause of unfitness due to the loss of For this specialist field, any refractive surgery carried depth-perception. out before admission to this specialist field remains a major cause of unfitness today.An exemption from CONCLUSION medical standards can possibly be given by the oph- thalmologist expert in aeronautics at the time of Laser corneal refractive surgery is a safe technique if recruitment, or an exemption can be given by the surgical indications are respected. A specialist’s medical Medical Aeronautics Commission for Defence (CMAD). advice is essential to ensure the quality of the anatomi- cal and functional results after surgery and their com- 5. Military sport parachuting patibility with the constraints of military environments. Refractive surgery is constantly evolving, so it is essen- Fitness must be given by a doctor of the local army tial to keep informed of new surgical procedures when medical center, holder of the aeronautical medical cer- deciding on the fitness to serve. tificate or a certificate of medicine applied to parachu- ting. The medical standards in force by the French ABSTRACT Federation of Parachuting (FFP) must be respected. The FFP standards are imprecise as the text stipulates that Refractive eye surgery includes any eye surgery aimed at “refractive surgery is to be evaluated”. Corneal refrac- improving the refractive state of the eye and decreasing tive surgeries are not a contra-indication for sport para- or eliminating the dependency on glasses or contact chuting as long as the applicant does not have a dege- lenses that can affect military operations. Laser corneal nerative lesion to the retinal periphery that is at risk of refractive surgery techniques include photorefractive retinal detachment. keratectomy (PRK), laser assisted in situ keratomileusis (LASIK) and small incision lenticule extraction (SMILE). IN PRACTICE Intraocular refractive surgery involves implanting a lens inside the eye, which is a state incompatible with mili- The absence of glasses or contact lenses brings a real tary parachuting. Laser corneal refractive surgery is a operational benefit to jumpers.There is no longer a safe technique if surgical indications are respected. A risk of losing the correction during a jump, the wearing specialist’s medical advice is essential to ensure the qua- of protection or sighting systems is no longer hampe- lity of the anatomical and functional results after surgery red by the frame of the glasses. Modern corneal refrac- and their compatibility with the constraints of military tive surgery techniques (PRK, LASIK and SMILE) are not environments. Side effects or complications of refractive VOL. a contra-indication to the practice of parachuting, even at surgery may, for some military personnel, be a cause of 94/3 very high altitudes in French armed forces. Most subjects incapacity for their specialty. Refractive surgery is International Review of the Armed Forces Medical Services 46 Revue Internationale des Services de Santé des Forces Armées