contact lens care
Contact Lens Wear in The Middle East
BY SUSAN J. GROMACKI, OD, MS, FAAO

Nearly 300,000 Americans have been sent to serve in the Middle East. Although many have returned home safely to their families, thousands more are being deployed. It's a good bet that one or more of your patients has been there or will go there in the future. What can you tell them about contact lens wearing conditions in Afghanistan and Iraq?

The Conditions "Over There"

Major Rob Gwinner led American soldiers during Operation Iraqi Freedom. Even his wife Catherine was not allowed to know exactly where he was located "over there." In their few brief conversations since his deployment in March, he has indicated that the weather is brutal. The average high temperature for July, for example, is 110 degrees Fahrenheit.

What's worse is that Iraq is comprised mostly of desert. Windstorms blow for days without ceasing and sand infiltrates everywhere and everything. This includes soldiers' glasses and contact lenses, rendering goggles essential.

Lieutenant Colonel Dan Ragsdale, PhD, served in Afghanistan after the conclusion of the hostilities. As Director of Assessment and Military Planning, he rarely ventured outside of the tent that served as his office. Nonetheless, he described a "120-day wind," which blew gray-brown dust so thick it limited visibility to 10 feet. In his three months in Iraq, the weather conditions on three days prohibited him from wearing his contact lenses.

Army Regulations Set Limits

Adverse climates are one reason that Army Regulation AR 40-5 exists. It states, "Contact lens use will be prohibited during gas chamber exercises, field training, and combat." The "field" is generally an austere setting in which soldiers would wear their helmets and combat equipment. Before deploying, military personnel who require visual correction (40 percent of the more than 500,000 soldiers, sailors and airmen) must possess two pairs of prescription spectacles and one prescription insert for their gas mask.

The potential for serious problems with contact lens wear exists in the event of a chemical or projectile attack. In addition, G-forces could dislodge a contact lens. These events may cause visual loss for the soldier or render him unable to protect his life or that of his fellow soldiers.

Nevertheless, some soldiers, especially those who have high myopia, choose to wear contact lenses. The Army does not dispute contact lens advantages such as comfort, enhanced peripheral vision and increased image size in myopia. As a result, some soldiers, including Army aviators, are authorized to wear them in operational environments.

Surgical Steps

Spectacles are not a perfect solution. They can fog or dislodge during combat. As a result, the Army approved refractive surgery for soldiers in 2000. Before this, refractive surgery was not available in military hospitals and anyone who had a history of refractive surgery could not enlist.

The eight existing Army refractive surgery centers have performed 8,000 procedures to date. Special forces receive first priority, followed by others who are deemed likely to face combat (infantry, armor, artillery or combat engineers) and finally all other personnel on a space-available basis. Only time will tell the success of refractive surgery in combat.

To conclude, I want to thank all of the men and women in uniform for their selfless sacrifices for our country and for their help in maintaining peace around the world.

Dr. Gromacki has a specialty contact lens practice as part of a multi-subspecialty ophthalmology group in Fishkill, NY, and has served as a faculty member at the University of Michigan Department of Ophthalmology and Visual Sciences.