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Refraction Error DQ


HerkJDriver

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Hey guys looking for some info on this peculiar situation. 
 
I was fortunate enough to be picked up for a UPT position by an ANG C-130J unit back in February of 2022. Today at MEPS I was deemed disqualified due to my Refraction Error in my left eye being a 3.25 (3.0 Refraction Error limit). This came as a surprise to me because in April of 2022 at my civilian Optometrist, my vision prescription was a 2.75 Refraction Error astigmatism in each eye (please see attached photo). My astigmatism has also never been above a 3.0 Refraction Error for 10 years have worn contacts. I was told by the Optometrist Technician at MEPS that this drastic deviation is because the machines at MEPS are so outdated and do not have the ability to get that precise of a reading. I also failed the depth perception exam.
 
Regardless, it appears I have a waiver process ahead of me for depth perception and Refraction Error. I have referenced the waiver guide and it appears depth perception can be taken care of with a waiver, however, above a 3.0 Refraction Error astigmatism is not waiverable. I then looked at the Refraction Error numbers needed for pre-op LASIK or PKR and it is showing the same, not eligible above a 3.0 refraction error. At this point, I'm having a hard time finding my next steps. My eyes have never caused me issues and I'm worried I will be permanently DQ'ed and have to forfeit my position. I would love it if someone could provide any form of assistance on this matter or let me know if I am even reading the waiver guide correctly.
 
Additionally, I would love to hear if anyone has gone through this process and what worked for them, or if there is a specific Optometrist in the Texas area well versed in putting together a waiver examination and letter for UPT applicants
 
Thank you very much and looking forward to sharing my experience and paying it forward when this is all said and done.

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Herk,

Congrats on being picked up.  

The photo you show is your prescription for contact lenses.  This will correlate, but will not be exactly the same, as your glasses prescription which is measured during all physicals.

I have a couple of questions.  Did the optometrist at MEPS do a refraction (i.e. which is better, one or two)?  Was it done after dilation?  That's what determines where you stand.  The equipment used at MEPS, however old, should not change this finding.  My best guess is that MEPS probably did it wrong.  Just my biased guess.

If you can't fight their findings, here are your options:

1.  Astigmatism greater than 3.00 is not waiverable for flying class one.  It's pretty much a hard line.

2.  You could get LASIK or PRK.  Untrained aircrew (i.e. applicants) are allowed up to 6.00 Diopters before surgery.  That changed someone around 2018/2019 so you might be looking at an older policy.

My recommendation is to refute the MEPS exam if they didn't do it exactly like it is specified in policy.  After 2 drops of cyclopentolate and only to an acuity of 20/20.  See Note 3 of Table One of the Medical Standards Directory.

Let me know what you find.

Cheers,

Steve

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7 minutes ago, stuckindayton said:

This will correlate, but will not be exactly the same, as your glasses prescription which is measured during all physicals.

 

I only wear contacts and have not worn glasses for 10 years. My very first prescription was a glasses prescription and I keep those rolling around in my flight bag for a just-in-case scenario, but haven't had a glasses prescription since 2013.

 

10 minutes ago, stuckindayton said:

Did the optometrist at MEPS do a refraction (i.e. which is better, one or two)?  Was it done after dilation?  That's what determines where you stand

They did a brief refraction, like 2-3 slides, but no dilation. Also, I feared the same thing the idea that "they messed something up"  and knew over a 3.00 was a DQ so I actually somehow convinced MEPS to re-do that portion of my vision exam with a different optometrist technician facilitating the exam on another machine to eliminate redundancy and still came out with a 3.25.

I sincerely appreciate the reply and checked out the Medical Standards Directory under note 3, but would that apply to me even if I'm corrected to 20/20 with no issues?

Pretty re-assuring that LASIK / PKR is still an option.

 

 

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Wait, are you currently aircrew for the AF?  That creates an odd situation for PRK/LASIK.  The limit is 6.00 D pre-op for aircrew applicants, but 3.00 D for current aircrew.  If you are AF aircrew, are you AD, ANG, AFRES?  If you are civilian aircrew then disregard, the 6.00 D applies.

Even if you only wear contact lenses, you still have to get a refraction during your exam.  Plus, if you wear contact lenses, the AF policy states that your physical must be done at least two weeks after d/c contact lenses (Note 4 of Table 1 in the MSD).

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11 minutes ago, stuckindayton said:

Wait, are you currently aircrew for the AF

Sorry for the confusion, I am an off-the-street civilian hire, not in aircrew so the 6.00 D applies, but I'm still having a hard time finding the document that states that. The first photo attached is from the FC I/MFS CORNEAL REFRACTIVE SURGERY (CRS) CHECKLIST clearly stating 3.0 max astigmatism pre-op, and the second image is directly from the most recent waiver guide. Under the circumstance of the second table "Aviation and Aviation-related Special Duty" (AASD) states I can extend the 3.0 D limit to 6.00 D, if I met all other vision requirements which I did, besides depth perception. Would the Depth perception failure throw off this exception / be an issue?

 

20 minutes ago, stuckindayton said:

Plus, if you wear contact lenses, the AF policy states that your physical must be done at least two weeks after d/c contact lenses (Note 4 of Table 1 in the MSD).

I'm reading in note 4 that this is required "before all initial flying examinations" which wouldn't be MEPS correct? 

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I'll agree, this is confusing.  The pre-op limits of +3.00/-8.00 and 3.00 D of astigmatism were the old limits for everybody- trained aircrew and aircrew applicants.  They had been the limits for decades and the AF decided it was time to raise the limits to reflect improvements in technology.  So the limits of +3.00/-8.00 and 3.00 D are the limits of what does NOT require a waiver if the outcome is good.  Above that, as you see in Table 4 is the "no shit" limits for what the AF will consider for waiver.  There are some weird reasons when the hyperopia and astigmatism limits are different for trained versus untrained, but I honestly don't remember them anymore.  If you are a civilian applicant, you fall under untrained.  Thus, you are allowed to go to those limits.  If you are above -8.00/+3.00 and 3 D of astigmatism then you would need a waiver.  As long as the procedure is relatively successful you should be fine.

The depth perception issue would have to be completely re-evaluated after PRK or LASIK.  Note that there is also a 6 month wait time between PRK/LASIK and getting re-evaluated.  It's one year for hyperopic (plus) treatments, but I don't think they'd consider your treatment hyperopic since you'd mostly be correcting the astigmatism which is myopic astigmatism.

Does that make any sense?

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10 minutes ago, stuckindayton said:

Does that make any sense?

Yes, this does make sense, sounds like I won't need a waiver for pre-op LASIK or PRK, only a successful surgery, and a good re-eval 6 months post-op since I'm a -3.25 astigmatism.

I seriously cannot thank you enough, my recruiter is MIA and I'm trying my hardest to navigate these waiver guides. Now I just have to find a good doc and hope my unit is cool with waiting 6 months for me to get re-tested post-op. Thank you again @stuckindayton I owe you a beer.

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Well if your pre-op astigmatism is listed as 3.25 by your surgeon, then you would need a waiver to be FC I qualified, but that won't kick in until you get re-evaluated by the AF.  Until then, it's just between you and a LASIK/PRK surgeon if that's the way you choose to go.

Happy to help.  Keeps my old brain going in these retirement days.

Cheers,

Steve

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@stuckindayton

Just got my MEPS results back in my possession from my recruiter. I will attach an image of my vision results below.  

After talking to my recruiter it does sound like I only have 2-3 options:

1. Outside MEPS Consult: I will put together a packet of local optometrist / ophthalmologist results showing I am a 3.00 or 3.25 or below and have them state that this will not affect my time in service (but quick question, would I have to go through that exact waiver again in FC1?)

2. LASIK / PRK but still would need a waiver for that since I am documented as a 3.25 from MEPS and fall outside of the 3.00 pre-op limit correct? and hope my unit will wait 6-8 months for me to get a waiver and go back to MEPS post-op (That table 4 still confuses me slightly sorry for beating the dead horse)

3. Exception to Policy: Really do not want to go down this road, but afraid it might come to this. Any advice on this outside of writing state reps, congress, governor and senators?

Thanks again

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There's really a couple of things going on that I would have issue with.  First, the only measurement of refraction is an autorefraction and that is, frankly, garbage.  It's a computer estimate of your prescription and it's often way off.  Furthermore, it's not the way we measure refractions for flight physicals.  That is based on the doctor's exam, after your eyes are dilated and only to 20/20 (which will always yield a lower prescription) versus to your best vision.  Maybe they did that as well, but it's not documented here.  If they didn't do that, then you shouldn't be disqualified from FC I per AF policy.  Second, how did they test your depth perception?  By FC I policy, it must be done with your best correction in place and it must be with glasses.  If you don't have glasses that are your best prescription and they didn't make any for you, then that didn't meet FC I policy.

So are they going to DQ you from FC I despite not doing the proper tests?  I don't know how that works at MEPS.  I only saw patients who made it to Wright-Patt.  I'd hope they weren't DQing people improperly without giving us the chance to do it right.  I know we saw a lot of people who didn't meet refractive standards, but I don't know if they were DQing others and we never saw them.  Unless there's more to the story, I'd address the fact that MEPS isn't doing to physical properly to DQ you from an FC I slot.  I don't know, maybe that's how MEPS works.  But, I was at USAFSAM for almost 20 years and that's not how we did things.

Table 4 confuses everybody, myself included when it first came out.  It was just an attempt to make PRK and LASIK less restrictive for everybody, but for various reasons they didn't want the limits to be the same for trained aircrew versus applicants, thus we have all sorts of inconsistencies.

If you are sure that there's no more documentation, I can ask a few of the admin folks if they run into this and how they handle it.  Seems silly to risk losing a C-130 slot over stupidity.

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  • 3 weeks later...

 

Hey @stuckindayton

Thought I would give a quick update. I decided to go the route of seeking a waiver rather than LASIK or PRK because I'm honestly not sure if my unit would wait 6 months before my re-evaluation. That being said, I started seeking outside Optometry consultations and building my waiver packet for the Surgeon General. Good news, during all of my Optometry exams including one where I was dilated in both eyes, I'm showing a 2.75 D Astigmatism in my right eye and 3.00 D Astigmatism in my left eye. I also showed no sign of depth perception issues.

I'm hopeful these letters from the Docs will provide enough context to warrant an approved waiver from the SG and I can finally make it through MEPS. From what I've read, the FC1 sounds like a place where the Docs and staff advocate potential pilots more than MEPS. Thank you again for all of your advice and all the information you were willing to provide it means more than I can put into words!

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  • 4 weeks later...

Hey all, another optometry question here. I'm attempting the gauge the likelihood that I would fail the refraction error requirements during FC1. ...@stuckindayton, I've spent the last few hours reading all your comments, hoping you may be willing to weigh in.

I'm a current AD enlisted flyer (airborne linguist) submitting my rated OTS app in a just a few days. I planned to list CSO and pilot, but based on the MSD I would DQ the FC1 for pilot due to my current -3.75/-3.5 eyeglass prescription issued in 2021. HOWEVER, in 2020 my prescription was -3/-2.75 (passing). It's noted in my records that this was an unusually high jump in a single year, and at the time, I did feel that it was overcorrected (probably my fault for being indecisive with the lens options). I understand that an eyeglass prescriptions correlate but don't predict IFC eye exams results. With no waiver potential for refractive error >-3.00, just wondering if I have a shot, or if there's no way in hell and I need to remove pilot from my application.

Being selected for pilot, DQ'ing FC1, and potentially wasting my/other people's shot at OTS for an issue I knew I had is my worst nightmare. My leadership says to send it, but they also thought that correctable to 20/20 was enough, so I don't fully trust them. 

I have my annual optometry appt next month (after application submission) and can't bee seen any sooner2021.pdf. We'll see what comes of that, but I'll be hoping for a lower prescription. Ophthalmology exams attached. Do I have any shot at pilot eyes?

 

2020.pdf

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7 hours ago, Mrs. Zero said:

Hey all, another optometry question here. I'm attempting the gauge the likelihood that I would fail the refraction error requirements during FC1. ...@stuckindayton, I've spent the last few hours reading all your comments, hoping you may be willing to weigh in.

I'm a current AD enlisted flyer (airborne linguist) submitting my rated OTS app in a just a few days. I planned to list CSO and pilot, but based on the MSD I would DQ the FC1 for pilot due to my current -3.75/-3.5 eyeglass prescription issued in 2021. HOWEVER, in 2020 my prescription was -3/-2.75 (passing). It's noted in my records that this was an unusually high jump in a single year, and at the time, I did feel that it was overcorrected (probably my fault for being indecisive with the lens options). I understand that an eyeglass prescriptions correlate but don't predict IFC eye exams results. With no waiver potential for refractive error >-3.00, just wondering if I have a shot, or if there's no way in hell and I need to remove pilot from my application.

Being selected for pilot, DQ'ing FC1, and potentially wasting my/other people's shot at OTS for an issue I knew I had is my worst nightmare. My leadership says to send it, but they also thought that correctable to 20/20 was enough, so I don't fully trust them. 

I have my annual optometry appt next month (after application submission) and can't bee seen any sooner2021.pdf. We'll see what comes of that, but I'll be hoping for a lower prescription. Ophthalmology exams attached. Do I have any shot at pilot eyes?

 

2020.pdf 1.01 MB · 1 download

Hey Mrs. Zero,

I think you understand the situation very well.  Not sure I can add a lot, but I'll try.  First off, there is no wiggle room over -3.00.  Historically, it's been a hard line in the sand.  So you are correct, at your current prescription you are not going to be accepted.  However, as you also point out, the FCI is done differently than a glasses prescription and is always going to be a little bit lower (at least for near-sighted people).  Anywhere from 0.25 to 0.75 lower in most cases.  And the docs at Wright-Patt will definitely do anything they can to keep you within standard.

I agree with you that the change from 2020 to 2021 is a pretty big jump.  Not terribly uncommon with teenagers, but not expected for someone in their 20's or later.  Is your vision through glasses from your 2020 exam really lousy?  If so, then maybe the change is real.  If not, then the extra power probably wasn't necessary.

Do not feel bad about applying, even if you are over -3.00.  It happens frequently and no one gives you grief about it.  You always have the option of PRK/LASIK with only a six month wait after surgery to be re-evaluated.  The clock starts on the day of surgery and you have to be six months out on the day of your FC I exam.  So, you can get the application started much earlier than six months.  Heck, if you are active duty and your commander approves, you can even get the procedure on the AF's dime.

Bottom line, go for it.  If you get the FC I done and end up over -3.00, you can always get PRK/LASIK afterwards and only have to recomplete a small portion of the eye exam.

Best of luck,

Steve

 

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Steve, 

Thanks so much for the reply. This forum is amazing, as is your willingness to share your insights. 

8 hours ago, stuckindayton said:

the FCI is done differently than a glasses prescription and is always going to be a little bit lower (at least for near-sighted people).  Anywhere from 0.25 to 0.75 lower in most cases.

And what makes the FC1 return slightly lower results- is it the use of cycloplegic refraction, or other stuff? Looks like my 2021 exam had cycloplegic refraction, but the 2020 exam did not. 

6 hours ago, stuckindayton said:

I agree with you that the change from 2020 to 2021 is a pretty big jump.  Not terribly uncommon with teenagers, but not expected for someone in their 20's or later.  Is your vision through glasses from your 2020 exam really lousy? 

I've been wearing my previous script for the past few days. There is a minor difference in distant vision, but I certainly wouldn't call it lousy. FWIW, I was in my early 30's (and no pregnancy) when the jump happened.

8 hours ago, stuckindayton said:

Bottom line, go for it.  If you get the FC I done and end up over -3.00, you can always get PRK/LASIK afterwards and only have to recomplete a small portion of the eye exam.

Is it possible to get PRK between failing the FC1 and going to OTS, all while keeping the pilot spot? The max time limit between selection and starting OTS is 450 days (14.8 mo), so there's time to squeeze it in surgery + 6 months, just not sure if that's allowed. I've heard post-DQ the AF could either offer you another job or just tell you to kick rocks (forfeit your spot, be free to re-apply and compete for re-selection). Can I just tell them: "but wait, I get my eyes fixed!"

Anyway, with your words of encouragement, I'm going to send it and see what happens. Seriously, thanks for all your posts here. They have been invaluable in my attempt to decipher all the medical regs and results.  

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On 9/23/2022 at 4:03 PM, Mrs. Zero said:

And what makes the FC1 return slightly lower results- is it the use of cycloplegic refraction, or other stuff? Looks like my 2021 exam had cycloplegic refraction, but the 2020 exam did not. 

The cycloplegic is one factor.  The other is that the refraction does not push power to give you the best visual acuity (i.e. 20/15 or 20/10).  They add power until you can clear the 20/20 line and then stop.

On 9/23/2022 at 4:03 PM, Mrs. Zero said:

I've been wearing my previous script for the past few days. There is a minor difference in distant vision, but I certainly wouldn't call it lousy. FWIW, I was in my early 30's (and no pregnancy) when the jump happened.

That suggests the extra power wasn't necessary.  You can still see well when a doc gives you additional lens power, but it's not necessary and can lead to headaches and eye fatigue which is why we try to avoid doing this.

On 9/23/2022 at 4:03 PM, Mrs. Zero said:

Is it possible to get PRK between failing the FC1 and going to OTS, all while keeping the pilot spot? The max time limit between selection and starting OTS is 450 days (14.8 mo), so there's time to squeeze it in surgery + 6 months, just not sure if that's allowed. I've heard post-DQ the AF could either offer you another job or just tell you to kick rocks (forfeit your spot, be free to re-apply and compete for re-selection). Can I just tell them: "but wait, I get my eyes fixed!"

Yes, you can get refractive surgery after the FC I.  In the past, we would just put the FC I on hold and then submit after the surgery.  But, AETC didn't like us doing this so I believe the new process is to submit the FC I as a DQ if you are over -3.00 and then file an addendum after the surgery has been completed and you are successfully recovered and seeing well.  I'll check on this and let you know if I'm wrong.

On 9/23/2022 at 4:03 PM, Mrs. Zero said:

Anyway, with your words of encouragement, I'm going to send it and see what happens. Seriously, thanks for all your posts here. They have been invaluable in my attempt to decipher all the medical regs and results.  

I think it's worth pushing forward.

Let me know if you have any other questions.  I'll check on the process for getting PRK after the FC I if it becomes necessary.

Steve

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  • 4 weeks later...

Throwing this in here for visibility and to hopefully help whoever else is going through a similar situation. 

 

I was fortunate enough to have my MEPS medical waiver approved in less than 24 hours.

Some of the things I did that paid dividends were:

     -Learning about the issue and advocating for myself

     -Learning as much as I could from people who were extremely knowledgeable and willing to offer help like @stuckindayton

     -Using some medical consulting from Rocky "Apollo" Jedick over at https://goflightmedicine.com/ he wrote me an incredible letter to attach to my waiver that bridged the gap between my civilian optometrist's letters and the verbiage that the USAF and DOD likes to see.

 

Best of luck to whoever finds themselves in a similar situation. My DM's are always open and I'd be happy to help!

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  • 3 weeks later...

Quick question I wanted to add on here after reading this discussion. 

As someone in a similar position as you (myopia outside standard limits), would you guys recommend to get LASIK before starting OTS / ROTC? Or do it through the Air Force? 
 

I start Air Force ROTC next year and am wondering whether doing the surgery before will mess up my chances of a pilot slot? 
 

Cheers and good day. 

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2 hours ago, AV4Life said:

Quick question I wanted to add on here after reading this discussion. 

As someone in a similar position as you (myopia outside standard limits), would you guys recommend to get LASIK before starting OTS / ROTC? Or do it through the Air Force? 
 

I start Air Force ROTC next year and am wondering whether doing the surgery before will mess up my chances of a pilot slot? 
 

Cheers and good day. 

Trying to get refractive surgery through the military can be a crap shoot.  Historically, optometry manning has been a bottleneck and can make it tough to get treated on the Air Force's dime.

If you live near a base that has a surgery center (Lackland, USAFA, Andrews, Wright-Patt, Keesler, Travis, JBER, etc), you can typically get it done since the surgery center can do the pre/post op exams.  If you are stationed away from those locations, your local optometry clinic may not have the resources to support and if they can't support it, you can't get it done via the military.  You can always go the civilian route at your expense, but once you are active duty you must go through the "off base elective medical procedure" process which adds a bunch of hoops which can range from being inconvenient at a minimum and sometimes means you aren't allowed to do it at all.

People on flight status have better luck get surgery at military facilities since they are the highest priority, but others may not be so lucky.

AF surgery centers are equipped with very good technology and outcomes are excellent.  It's just an extremely limited resource.  Getting it done on your own ahead of time is certainly the path of least resistance.

 

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20 minutes ago, stuckindayton said:

You can always go the civilian route at your expense, but once you are active duty you must go through the "off base elective medical procedure" process

All that sounds good. However, given my current situation as a college student (civilian) — do you think I should do the LASIK or PRK asap as a civilian, or wait to consult my ROTC detachment later down the line? 

Reason I’m asking is because 2 things are of concern here. #1, I’m on the severe side of Myopia and nearing the waiverable limits for pre-refractive surgery diopters. In addition, I’m 18, so I don’t want it to possibly degrade for another 2 years. 
 

#2. I’m been made aware that there’s about a 6 month wait gap for flying duties. It may, therefore, be wise to bypass that while I’m ahead. 

Last thing (I know you mentioned this briefly), how likely is it that doing refractive surgery on the civilian side can cause a medical DQ with the Air Force? Obviously, we want to mitigate that risk as much as possible. 
 

Sorry for so many questions, I’m quite ignorant on the subject yet have been trying to get answers on this for years. 
 

I appreciate your timely response, Steve
 

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Refractive surgery alone is extremely unlikely to result in a DQ.  If you have very high myopia, there are other things that could be an issue, mostly related to the retina (lattice degeneration, staphyloma, retinal holes, etc).  For applicants, those are generally not waived when related to high myopia even when treated with refractive surgery.

Most surgeons would recommend waiting until your eyes have stabilized to get surgery since they will keep changing afterwards.  However, the UPT situation puts a unique spin on this.  It's not really an elective procedure at that point.  That's a discussion you can have with your surgeon.  If you are near the true waiverable limit (-10.00 D per my source) then get the surgery ASAP.  If you go over -10.00 you most likely aren't going to get a waiver.

You can always get PRK/LASIK in ROTC (I believe).  The issues with navigating civilian treatment outside of the military don't begin until you enter active duty.

Questions are no problem.  Ask away.  I'm retired, I've got all the time in the world.

Steve

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1 hour ago, stuckindayton said:

Refractive surgery alone is extremely unlikely to result in a DQ.  If you have very high myopia, there are other things that could be an issue, mostly related to the retina (lattice degeneration, staphyloma, retinal holes, etc).  For applicants, those are generally not waived when related to high myopia even when treated with refractive surgery.

Most surgeons would recommend waiting until your eyes have stabilized to get surgery since they will keep changing afterwards.  However, the UPT situation puts a unique spin on this.  It's not really an elective procedure at that point.  That's a discussion you can have with your surgeon.  If you are near the true waiverable limit (-10.00 D per my source) then get the surgery ASAP.  If you go over -10.00 you most likely aren't going to get a waiver.

You can always get PRK/LASIK in ROTC (I believe).  The issues with navigating civilian treatment outside of the military don't begin until you enter active duty.

Questions are no problem.  Ask away.  I'm retired, I've got all the time in the world.

Steve

Really a bro move to continue to hang out on here, as a retired guy, and still willing to do research for people especially. Much appreciated, Doc 

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18 hours ago, stuckindayton said:

If you are near the true waiverable limit (-10.00 D per my source) then get the surgery ASAP.

Copy all. Coincidentally, this month I have my annual check up at the eye doctor. So, I’ll talk to them about it, gather as much information, and potentially go on from there and start the process. Luckily, my eyes have been relatively stable the last 3 years (potentially from good diet and exercise, not sure). I’ll update again at some point with my findings, just to help any interested parties who want to read up on this. 

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