CF H Svcs Gp Policy and Guidance
Laser Eye Surgery
Document Status: Document Type: Policy Number: Original Source: Approval: SME: OPI: Effective Date:Last Reviewed: Interim GuidanceGuidance4020-01N/AD H Svcs DelD H Svcs Del – SSO D & T SvcsD H Svcs Del – SSO D & T SvcsFebruary 200609 Sep 06
Background
1. Kerato-refractive surgery including radial keratotomy and photoablative keratectomy (laser eye surgery) are considered to be medically unnecessary procedures that fall outside the Spectrum of Care (SoC). These procedures fall under the realm of voluntary and elective medical procedures. As such, members who choose to undergo these procedures do so at their own cost. Annual leave is required for the procedure, any period of convalescence, and follow up. All costs for consultation, follow up, home care, supplies etc are the responsibility of the member. See medications section for specific details. However, in the event of a significant medical complication, sick leave and subsequent costs will qualify under the Spectrum of Care.
2. Where glasses are required, they will not be supplied until the member returns to full duty status.
3. Historically, members that underwent kerato-refractive surgery were required to be placed on a temporary category. However, Surg Gen Directive 3/92 Kerato-Refractive Surgery, the key document that outlined the requirement for a change of medical category, has been cancelled. There is no intention at this time to develop a specific policy for a mandatory medical category for laser eye surgery except for aircrew and divers.
Abstract
4. This policy provides interim guidance for CF H Svcs Gp personnel providing advice and care to those CF members considering laser eye surgery on a wholly voluntary and elective basis.
Policy
5. Members who choose to undergo laser eye surgery will be treated the same as for any other medical procedure. As mentioned above, a temporary category is not automatically required except for Aircrew and Divers. The Opthalmologist should, where required and appropriate, provide draft specific medical employment limitations (MELs) and requirements for follow-up. The treating ophthalmologists recommendations will provide a framework for decisions regarding temporary category status as determined by the Medical Officer. For example, although specific studies have not been conducted, considerations for MELs include waiting at least one month post-surgery before undergoing CS Gas hut training and use of RSDL training lotion. Such brief limitations could be reasonably conveyed using a CF 2018.
Aircrew
6. Pilots are not authorized to undergo laser eye surgery. However, non pilot Aircrew may undergo laser eye surgery as outlined in the Flight Surgeon Guidelines. Divers are treated in much the same way as Aircrew, and cases for both groups need to be reviewed by the Aerospace and Undersea Medical Board (AUMB).
Medications
7. Medications are not normally covered under the SoC for voluntary and elective procedures such as laser eye surgery. When a member presents to a civilian pharmacy, however, there is no mechanism in place to identify the procedure for which the prescription is written, and as a result the prescriptions are filled if available on the Drug Benefit List. Effective immediately, in an effort to ensure that all military personnel receive a consistent standard of care, medications for laser eye surgery will be covered under SoC only if they are listed on the CF Drug Benefit List until further review of this issue is conducted.
Outstanding Issues – Requirement for a Broader Policy on All Elective/Voluntary Medical Procedures
8. D Med Pol – Policy is currently drafting a policy regarding all voluntary and elective procedures. This policy will address a number of outstanding issues in greater clarity, such as the member's obligation to inform the CO that MELs may be instituted following a period of leave. This requirement to inform the CO is the case for other out of spectrum of care elective surgeries such as cosmetic surgery. When a member proceeds on annual leave for the purposes of such procedures and does not inform the CO ahead of time, there is a potential for a negative impact on operations. QR&Os may eventually need to be amended to reflect the member's obligation to inform the CO. At present, no such direction exists. Ideally, the patient would report to a Health Care Provider (HCP) to determine whether the procedure is covered under the SoC. Where the procedure is not covered, the HCP can advise the patient regarding his/her responsibility for all costs for the procedure/ medications etc and follow up as well as the requirement to take annual vs sick leave. There is also an opportunity to discuss possible career/ medical/ administrative implications in the case of an adverse event and to direct the patient on what to do in the event of complications arising from the surgery. Informed consent may be obtained to have the medical records transferred to the CF. The HCP can then advise the CO of anticipated MELs, and the CO and the member can work out the optimal timing for the procedure.
Future Direction
9. The feasibility of covering laser eye surgery under the SoC has been discussed in the past and will likely continue to be revisited. However, there are no immediate plans to offer laser eye surgery through the SoC.
References
A. CF Spectrum of Care
B. ADM(HR-Mil) Voluntary and Elective Procedures (in draft)
