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National research Council (US) Working team on contact Lens usage Under adverse Conditions; Ebert Flattau P, editor. Considerations in call Lens usage Under disadvantage Conditions: Proceedings of a Symposium. Washington (DC): nationwide Academies push (US); 1991.


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Considerations in call Lens usage Under disadvantage Conditions: Proceedings that a Symposium.

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National study Council (US) Working group on call Lens use Under disadvantage Conditions; Ebert Flattau P, editor.

James Socks

The submariner working in a clean setting with humidity of roughly 50 percent will have a greater choice of contact lens species than the helicopter pilot who is exposed come dust and wind. The risks associated with extended-wear contact lenses are considerably different for each group, v the latter also having the heightened probability of international bodies under the lens, lens displacement, and lens loss.

The high-performance jet pilot, the astronaut, and the deep-sea diver will certainly each experience markedly different environments the will impact their capacity to wear call lenses and also the performance of the lenses in those particular environments.

What cd driver the use of contact lenses in the military and also where we room heading? Basically, that is the present regulations, the vision standards, loved one to each specialty community. We have actually heard over there is a manpower shortfall. A closer look at refractive error and also the connection of visual acuity ns think will certainly drive residence the point.

The vision of our aviators, or whatever the specialty happens to be, with a tiny bit that myopia, starts to drop turn off rather substantially and an especially when astigmatic error is included, as displayed by Peters (1961) in figure 1 . The aviator, then, has actually a great deal of difficulty performing the assigned task.


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FIGURE 1

Level of visual acuity produced by offered magnitudes the spherical and cylindrical errors (adapted indigenous Peters, 1961).


There is, of course, the difficulty of man/machine interface. Devices are developed without guy in mind, i m sorry is a significant problem. Hardware developers will build the periscopes, the night vision devices, the gas masks, and then present each to the armed forces community and also say “use it.” Then someone says, “but the male can"t see.” then it comes earlier to united state to resolve the problems.

Wearing contact lenses—be castle hydrogel or strictly gas-permeable (RGP) materials—coupled with diminished humidity reduces the obtainable oxygen come the cornea, which results in corneal swelling. Furthermore, the attract of those lenses for an extensive time results in additional decrease in oxygen accessibility over the food of the attract period. That outcomes in boosted swelling and a high probability of contact-lens-related complications.

In enhancement to the waiting Force and Army"s work scenarios, we need to keep in psychic that special combat devices operating at high hill altitudes in the cold space exposed come a diminished partial pressure of oxygen as well as the impacts of the cold. Furthermore, the U.S. Navy has given factor to consider to reducing the approximately partial press of oxygen aboard nuclear fleet ballistic missile and also nuclear strike submarines in order to decrease combustibility—thus, the ever-present peril of fire that exists on submarines.

In every of these instances ocular tissues have a reduced concentration of oxygen available, and also it is most likely that boosted insult come the cornea will an outcome from wearing contact lenses, specifically extended-wear lenses.


COMPRESSION and also DECOMPRESSION

In research studies of decompression we discovered that bubbles formed under hydrogel lenses throughout decompression (Molinari and Socks, 1987). Those bubbles left pitting that the cornea near the limbus. As soon as we go the same decompression researches with RGP lenses in hyperbaric chambers, there was central bubbling (Socks et al., 1987). Again, that evidenced the findings of Flynn et al. (1986) the pressure changes can result in pitting that the corneal epithelium.

The bubbles that developed underneath the lenses prospered rapidly in size throughout the decompression, then broken into multiple tiny bubbles as we got to the surface. Over a period of time, 2 come 3 hours, the dimpling disappeared. The is not recognized what the repeated impacts of exposure in hypobaric or hyperbaric environments would have actually on the cornea during extended operations.

Of specific interest to united state was the truth that development of bubbles developed from depths together shallow together 37.5 feet, i m sorry is fine within the boundaries of the no-decompression-dive tables collection by the U.S. Navy.


EXTREME ENVIRONMENTS

Extreme cold can be proficient by hill troops or possibly also by aviators in ~ high altitudes. However it is unlikely that there will certainly be a an unfavorable impact on contact lens undertake (Socks, 1981, 1982), other than for the fact that those settings are usually really dry. Actually, the wearing of contact lenses in extreme cold—and we are claimed to it is in talking about adverse atmospheres even despite we have spent most of our time speaking around the hypobaric high-altitude situation—will provide protection native wind-driven ice and snow (Kolstad and Opsahl, 1969).

The question was additionally raised around contaminants in the setting of the cockpit and also in any enclosed environment, and also we have noted that many chemicals and particulate matter can be found in the submarine setting (Knight et al., 1983). Reports indigenous submariners say the discomfort can take place at times as soon as wearing the call lenses plank ship. This discomfort is often related to excess gaseous chemicals in the environment of the submarine, those that room not scrubbed the end ( Table 1).


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TABLE 1

Actual or Potential resources of Contaminants in Submarine Atmospheres.


I will not study the risks of contact lens in detail since we space all aware of the particular risks of extended-wear lenses. I would prefer to say the the contraindications space the exact same for the military setting as they room for the civilian sector: inflammation, dry eye, corneal disease, and systemic condition with ocular overtones. Cautious screening and patient education are absolutely an essential to avoid problems during an work situation.

Regardless of even if it is hydrogel or RGP lenses are used by army personnel on an extended-wear basis, they need to have actually spare lenses, lens care solutions that room appropriate, and access to ideal health care professionals. Vital personnel wearing extended-wear contact lenses can not afford to be there is no spare lenses during crucial operations. Therefore, the preventive lenses should be readily easily accessible in situation of lose or damage to the first pair of lenses. Disposable lenses may be one alternative.

We also need come look at the lens treatment systems that room available. Call lens care systems play a an important role in the success the the call lens wearer. For armed forces operations simplicity is the an essential to compliance in the field. Storage/disinfecting solutions need to possess adequate antimicrobial activity, be nonsensitizing and also noncytotoxic, and have a high level of patience acceptability. Because of limited availability of supplies and storage space in the field, it is imperative the the care regime be limited to as couple of components as possible and the it be simple in design and also use. To this end, solutions must be multipurpose; the is, they must fill the requirements of storage, soaking, disinfecting, and rinsing. The very same solution might even be taken into consideration for use as a rewetting/comfort drop. Cleaners should possess enough efficacy to quickly remove the facility deposits that form on the lenses.


CURRENT military EXPERIENCE with EXTENDED-WEAR LENSES

My comments listed below are based upon work performed in ~ the marine Submarine clinical Research laboratory in Groton, Connecticut. Keep in mind that the submariner is presented through a particular problem, the capability of the periscope operator to interface with the periscope itself due to the fact that of the limitations of the optics to correct both spherical and astigmatic refractive error.

Figure 2 reflects the circulation of spectacle correction of the 154 officers and 20 enlisted males we studied. The form 18 periscope, i beg your pardon is uncovered on the Los Angeles class 688 assault submarines, corrects come plus or minus about 4.5 diopters.


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FIGURE 2

Distribution that spectacle corrections among submariners.


The entrance requirements to submarine service permit refractive spherical tantamount to add to or minus 5.5 diopters. Already the man who is in ~ the limits is handicapped due to the fact that he is 1 diopter undercorrected by the form 18 periscope. Include to that the allowable border on astigmatic error of 2 diopters.

It was determined that a feasibility research would be conducted. We ran this study from 1981 to 1984, primarily on fleet ballistic missile (FBM) submarine crews whose home port to be Groton, Connecticut (Socks, 1985).

FBM ships might not be wherein the crews are house ported, and in our case in brand-new London the ships room in the divine Loch, Scotland. The crews leave for 3 months and relieve the contrary crew once they arrive in the divine Loch. They go out on terminal for 70 days, however they space away from the basic area because that 3 months.

Remember 1981 was just after the first Hydrocurve and Cooper Permalenses were approved, so the products were early-generation extended-wear materials. We found some problems yet not very many in terms of lens replacement and tearing. This findings were no unexpected.

The other complications we discovered were minor, including four subjects through infiltrates and nine through minor neovascularization. This day we most likely would not even put in stippling and infiltrates.

As a matter of fact, there have actually been no far-reaching medical occasions in the time period that this program has actually been a fleetwide program—from around 1985, as soon as it to be initiated. In a examine of submariners right for contact lenses both under the navy program and also by non-Navy fitters, it was concluded the the risks linked with contact lens wear through submariners were low (Ulrich, 1987). Contact lenses are obtainable at government expense to every submariners who room qualified periscope operators. The marine will carry out the care, the lenses, and also the solutions. It has actually been a really successful program.

It has been successful, in part, due to the fact that the submariners space enthusiastic; they are highly educated; they comply really strictly v the lens treatment instructions. I think this grows out of the Rickover era, which affected the form of person who is accepted and trained in the atom submarine navy. The submariners receive consistent follow-up visits; hospital corpsmen were placed on the delivery to ensure that they return to the clinics. We have actually a solid patient education program and also in-depth cultivate of marine hospital corpsmen.


CONCLUSION

I think contact lenses in the cockpit room inevitable. The Army, Navy, and Air force will all have actually them. The equipment, the manpower, the vision requirements will need so.

We perfect the pilot program and also it was successful. The Air pressure is act a pilot routine feasibility study, and also to date it appears to be successful. I an obstacle the marine air community and also the army air community and special areas within the three solutions to likewise conduct pilot programs and also see what the result are.


Flynn, W.J., R.E. Miller, T.J. Tredici, M.G. Block, and also E E. Kirby1986. Subcontact Lens Bubble development Under low Atmospheric pressure Conditions. USAF school of Aerospace Medicine. Respectable 21. Report no. USAFSAM-TR-86-21. NTIS no. AD-A173.
Knight, D R., K.R. Bondi, and J.P. Malaspina1983. The analysis of French Submarine atmosphere Containments. Proceedings the the 3rd Tripartite Conference ~ above Submarine Medicine, France, joined Kingdom, and also United States. Marine Submarine clinical Research Laboratory. Special Report 83-1, June. NTIS no ADA 133150.
Molinari, J.F., and also J.F. Socks1987. Impacts of Hyperbaric problems on Corneal Physiology with Hydrogel contact Lenses. Naval Submarine clinical Research Laboratory. Report No. 1102. October. NTIS no A189152.
Socks, J.F.1981. Usage of contact Lenses because that Cold Weather Activities. Navy Submarine clinical Research Laboratory. Report No. 969. December. NTIS no. ADA 110020. 1982. Contact lenses in too much cold environments: an answer of hare corneas. American newspaper of Optometry and also Physiological Optics 59(4) : 297– 300. 1985. Call Lenses on Submarines. Naval Submarine medical Research Laboratory. Report No. 1048. April. NTIS no. A156900.

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Socks, J.F., J.F., Molinari, and also J.L. Rowery1989. Strict Gas Permeable call Lenses in Hyperbaric Environments. Navy Submarine medical Research Laboratory. Report No. 1100. August. NTIS no. A187744.
Ulrich, S.1987. Review of call lens use aboard submarines. Thesis because that designation together submarine clinical officer. Naval Undersea medical Institute, marine Submarine Base, Groton, Conn. :