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The pilot must see well at distance)Tj 0 -1.1891 TD 0.0235 Tc 0.2261 Tw (to detect and identify airborne traffic, as well as)Tj 0 -1.1782 TD 0.0232 Tc -0.0136 Tw (hazards that may be on runways and taxiways. Good)Tj T* 0.0236 Tc 0.1363 Tw (intermediate and near vision is also essential since)Tj 0 -1.1891 TD 0.1227 Tw (cockpit instruments and aviation materials such as)Tj 0 -1.1782 TD 0.0232 Tc 0.1688 Tw (flight manifests, charts, and maps must be clearly)Tj T* 0.0058 Tw (visible to properly execute flight procedures in vary-)Tj 0 -1.1891 TD 0.0239 Tc 0.0046 Tw (ing ambient light conditions.)Tj 1.0909 -1.1782 TD 0.0235 Tc 0.0506 Tw (Refractive error is an optical defect that prevents)Tj -1.0909 -1.1782 TD 0.0232 Tc 0.0463 Tw (light rays entering the eye to be focused as a single,)Tj 0 -1.1891 TD -0.0386 Tw (clear image on the retina. Blurred vision from refrac-)Tj 0 -1.1782 TD 0.0235 Tc 0.0712 Tw (tive error can interfere with a pilots ability to effi-)Tj T* 0.0217 Tc -0.125 Tw (ciently perform operational tasks and can compromise)Tj 0 -1.1891 TD 0.0235 Tc 0.1136 Tw (aviation safety. Common refractive conditions \(see)Tj 0 -1.1782 TD 0.0231 Tc -0.1065 Tw (Figure 1\) that are correctable with ophthalmic devices)Tj T* 0.2499 Tw (\(eyeglasses, contact lenses\) include myopia \(near-)Tj 0 -1.1891 TD 0.1568 Tw (sightedness\), hyperopia \(farsightedness\), and astig-)Tj 0 -1.1782 TD -0.0102 Tw (matism \(irregular corneal curvature\). Approximately)Tj T* 0.0233 Tc -0.0125 Tw (55% of the U.S. population rely on corrective lenses)Tj 0 -1.1891 TD 0.1443 Tw (to achieve a quality of vision satisfactory for their)Tj 0 -1.1782 TD 0.0225 Tc 0.0045 Tw (daily needs \(1\).)Tj 1.0909 -1.1782 TD 0.0233 Tc 0.1691 Tw (Civil airmen with refractive surgical procedures)Tj -1.0909 -1.1891 TD -0.0799 Tw (have been allowed to obtain Federal Aviation Admin-)Tj 0 -1.1782 TD 0.1598 Tw (istration \(FAA\) medical certificates since the early)Tj T* -0.0512 Tw (1980s. The majority of these airmen had a procedure)Tj 0 -1.1891 TD 0.0143 Tw (known as radial keratotomy \(RK\) performed to cor-)Tj 0 -1.1782 TD -0.0131 Tw (rect their defective distant vision. In 1995, the Food)Tj T* 0.0235 Tc -0.0559 Tw (and Drug Administration \(FDA\) approved the use of)Tj 0 -1.1891 TD 0.023 Tc 0.113 Tw (the excimer laser to perform refractive surgery \(2\).)Tj 0 -1.1782 TD 0.0232 Tc 0.2146 Tw (Laser procedures, such as photorefractive keratec-)Tj T* 0.0106 Tw (tomy \(PRK\) and laser-assisted in situ keratomileusis)Tj 0 -1.1891 TD 0.0409 Tw (\(LASIK\), are being performed on a rapidly growing)Tj 0 -1.1782 TD 0.0234 Tc -0.0325 Tw (number of people, including civilian pilots \(3\). Pres-)Tj T* 0.0727 Tw (ently, applicants with refractive surgical procedures)Tj 0 -1.1891 TD 0.0236 Tc 0.061 Tw (may obtain an airman medical certificate without a)Tj 0 -1.1782 TD 0.0233 Tc -0.0531 Tw (waiver if they meet the visual acuity standards for the)Tj T* 0.1299 Tw (class of medical certificate applied, and an eyecare)Tj 0 -1.1891 TD -0.0233 Tw (specialist verifies that their vision is stable, healing is)Tj 0 -1.1782 TD -0.0059 Tw (complete, and no glare intolerance is present \(4\).)Tj 1.0909 -1.1782 TD 0.0035 Tc -0.025 Tw (RK, PRK, and LASIK procedures are similar only in)Tj -1.0909 -1.1891 TD 0.0033 Tc -0.0101 Tw (that the goal is to improve uncorrected visual acuity by)Tj 0 -1.1782 TD 0.1305 Tw (permanently altering the curvature of the eyes outer)Tj T* 0.0032 Tc -0.0759 Tw [(surface or cornea. RK requires a surgeon to make a series)]TJ 0 -1.1891 TD 0.0034 Tc 0.2383 Tw (of spoke-like incisions around the periphery of the)Tj 22.9091 52.0036 TD 0.0033 Tc -0.0784 Tw (cornea that, once healed, flattens the cornea and reduces)Tj 0 -1.1782 TD 0.161 Tw (myopia. PRK reshapes the cornea through a process)Tj 0 -1.1891 TD 0.0032 Tc -0.0396 Tw (called photoablation, which utilizes the excimer laser to)Tj 0 -1.1782 TD 0.0034 Tc -0.0858 Tw (vaporize the corneas outer tissue. LASIK uses a specially)Tj T* 0.0032 Tc -0.0539 Tw (designed surgical scalpel \(microkeratome\) to slice a thin)Tj 0 -1.1891 TD 0.0034 Tc 0.1379 Tw (horizontal flap from the top of the cornea leaving it)Tj 0 -1.1782 TD 0.0031 Tc -0.0013 Tw (connected by a small hinge of tissue. The flap is folded)Tj T* -0.0863 Tw (aside, and the excimer laser is used to remove tissue from)Tj 0 -1.1891 TD -0.0318 Tw (the corneal stroma. The corneal flap is then returned to)Tj 0 -1.1782 TD 0.0036 Tc 0.0018 Tw (its original position \(see Figure 2\).)Tj 1.0909 -1.1782 TD 0.0232 Tc -0.0354 Tw (Approximately 1.3 million laser refractive surgical)Tj -1.0909 -1.1891 TD 0.0234 Tc -0.1153 Tw (procedures were performed in the United States in the)Tj 0 -1.1782 TD 0.0231 Tc -0.0888 Tw (year 2000 \(5\) and a 35 to 40% growth rate is expected)Tj T* 0.0346 Tw (over the next five years \(6\). Success rates of 90% or)Tj 0 -1.1891 TD 0.0233 Tc 0.0844 Tw (better have been reported for patients with low-to-)Tj 0 -1.1782 TD 0.023 Tc -0.0961 Tw (moderate myopia who have had laser refractive proce-)Tj T* -0.1159 Tw (dures \(7,8,9\). However, the criteria for success used in)Tj 0 -1.1891 TD 0.0232 Tc -0.1247 Tw (many of these studies permit uncorrected visual acuity)Tj 0 -1.1782 TD 0.023 Tc 0.0004 Tw (\(VA\) as low as 20/40 \(10\). While a VA in this range)Tj T* 0.0233 Tc 0.0669 Tw [(may be adequate for the general population, pilots,)]TJ 0 -1.1891 TD 0.1466 Tw (who must safely perform a wide variety of vision-)Tj 0 -1.1782 TD 0.1418 Tw (related flight operations under visually demanding)Tj T* 0.0235 Tc -0.0523 Tw (environmental conditions, may find these results un-)Tj 0 -1.1891 TD -0.0046 Tw (acceptable \(11\). Aviation concerns remain regarding)Tj 0 -1.1782 TD 0.0233 Tc -0.1034 Tw (the quality of the resulting vision correction \(12\), side)Tj T* 0.0235 Tc 0.0546 Tw (effects in the aviation environment \(13,14,15\), and)Tj 0 -1.1891 TD 0.0233 Tc 0.0028 Tw (the potential for surgical complications \(16,17\).)Tj 1.0909 -1.1782 TD 0.0235 Tc 0.0485 Tw (The aircraft accident experience of civilian pilots)Tj -1.0909 -1.1782 TD 0.0233 Tc -0.1078 Tw (with refractive surgical procedures has not been previ-)Tj 0 -1.1891 TD 0.1838 Tw (ously examined or reported. Studies by Dille and)Tj 0 -1.1782 TD -0.0111 Tw (Booze, conducted from 1976 to 1981, examined the)Tj T* 0.0237 Tc 0.2191 Tw (relationship between aviation accidents and static)Tj 0 -1.1891 TD 0.0233 Tc 0.1409 Tw (visual conditions \(18,19,20\). Two of these studies)Tj 0 -1.1782 TD 0.0237 Tc 0.2136 Tw (found statistically significant associations between)Tj T* 0.0148 Tc -0.125 Tw (certain visual conditions and aircraft accidents \(19,20\).)Tj 0 -1.1891 TD 0.0233 Tc 0.1084 Tw (At that time, refractive surgery was not commonly)Tj 0 -1.1782 TD 0.0235 Tc 0.0697 Tw (used by aviators and was not one of the conditions)Tj T* 0.0233 Tc 0.2013 Tw [(studied. The recent growth in popularity of laser)]TJ 0 -1.1891 TD 0.0331 Tw (refractive surgery prompted a review of the aviation)Tj 0 -1.1782 TD -0.0364 Tw (accident experience of airmen with refractive surgery)Tj T* 0.0231 Tc -0.0197 Tw (\(3\). A retrospective, cross-sectional cohort study was)Tj 0 -1.1891 TD 0.0233 Tc 0.1811 Tw (performed to determine whether accident rates of)Tj 0 -1.1782 TD 0.0773 Tw (airmen with refractive surgery differed significantly)Tj T* 0.0742 Tw (from those of airmen without refractive procedures)Tj 0 -1.1891 TD -0.0023 Tw (during the study period \(1994-96\).)Tj ET endstream endobj 32 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F2 5 0 R /F8 33 0 R >> /ExtGState << /GS4 34 0 R /GS5 35 0 R >> >> endobj 36 0 obj << /FunctionType 0 /Domain [0 1] /Range [-1 1] /BitsPerSample 16 /Size [256] /Length 527 /Filter /FlateDecode >> stream H  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ ? endstream endobj 37 0 obj << /Length 775 >> stream Microsoft PowerPoint - FIGURE-1 endstream endobj 40 0 obj << /Length 28685 >> stream BT /F1 1 Tf 10 0 0 10 295.44 36.96 Tm 0 0 0 1 k /GS4 gs 0 Tc 0 Tw (2)Tj ET /EmbeddedDocument /MC2 BDC q 1 i 92.04 738 411 -623.04 re 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453.983 l 237.12 453.263 l 237.12 452.303 l 237 451.583 l 236.88 450.623 l 236.88 449.903 l 236.76 449.062 l 236.76 443.902 l 236.88 443.062 l 236.88 442.222 l 237.12 440.542 l 237.12 439.822 l 237.24 438.862 l 237.36 438.142 l 237.48 437.302 l 237.72 436.342 l 237.84 435.742 l 238.08 434.061 l 238.32 433.221 l 238.56 432.621 l 238.8 431.781 l 239.04 431.061 l 239.16 430.221 l 239.4 429.381 l 239.76 428.661 l 240.24 427.221 l 240.6 426.381 l 240.84 425.661 l 241.56 424.221 l 241.8 423.621 l 242.28 422.901 l 243 421.461 l 243.6 422.781 l 243.96 423.501 l 244.2 424.221 l 244.56 424.941 l 244.8 425.661 l 245.16 426.261 l 245.4 427.101 l 245.64 427.701 l 245.88 428.541 l 246.36 429.981 l 246.6 430.821 l 246.84 431.541 l 246.96 432.381 l 247.2 432.981 l 247.44 433.822 l 247.56 434.542 l 247.68 435.502 l 247.8 436.222 l 248.16 437.062 l 248.28 437.902 l 248.4 438.622 l 248.52 439.582 l 248.52 440.302 l 248.76 441.982 l 248.76 443.662 l 248.88 444.502 l 248.88 447.982 l 248.76 448.702 l 248.76 450.503 l 248.52 452.183 l 248.52 452.903 l 248.4 453.863 l 248.28 454.583 l 248.16 455.423 l 247.8 456.143 l 247.68 457.103 l 247.56 457.823 l 247.44 458.663 l 247.2 459.383 l 246.96 460.223 l 246.84 461.063 l 246.6 461.783 l 246.36 462.623 l 246.12 463.223 l 245.88 464.063 l 245.64 464.783 l 245.16 466.464 l 244.8 467.064 l 244.56 467.904 l 244.2 468.624 l 243.96 469.344 l 243.6 469.944 l 243.36 470.784 l 243 471.504 l W* n 0.996 0.996 0.996 rg 236.76 447.862 12.12 -2.88 re f Q q 236.76 444.764 12.273 -11.456 re W n 236.76 444.982 12.12 -11.401 re W n 243 471.504 m 242.28 470.064 l 241.8 469.464 l 241.56 468.624 l 241.2 468.024 l 240.84 467.184 l 240.6 466.464 l 240.24 465.744 l 240 464.904 l 239.76 464.303 l 239.4 463.463 l 239.16 462.863 l 239.04 462.023 l 238.8 461.183 l 238.56 460.463 l 238.32 459.623 l 238.08 458.903 l 237.72 456.383 l 237.48 455.783 l 237.36 454.823 l 237.24 453.983 l 237.12 453.263 l 237.12 452.303 l 237 451.583 l 236.88 450.623 l 236.88 449.903 l 236.76 449.062 l 236.76 443.902 l 236.88 443.062 l 236.88 442.222 l 237.12 440.542 l 237.12 439.822 l 237.24 438.862 l 237.36 438.142 l 237.48 437.302 l 237.72 436.342 l 237.84 435.742 l 238.08 434.061 l 238.32 433.221 l 238.56 432.621 l 238.8 431.781 l 239.04 431.061 l 239.16 430.221 l 239.4 429.381 l 239.76 428.661 l 240.24 427.221 l 240.6 426.381 l 240.84 425.661 l 241.56 424.221 l 241.8 423.621 l 242.28 422.901 l 243 421.461 l 243.6 422.781 l 243.96 423.501 l 244.2 424.221 l 244.56 424.941 l 244.8 425.661 l 245.16 426.261 l 245.4 427.101 l 245.64 427.701 l 245.88 428.541 l 246.36 429.981 l 246.6 430.821 l 246.84 431.541 l 246.96 432.381 l 247.2 432.981 l 247.44 433.822 l 247.56 434.542 l 247.68 435.502 l 247.8 436.222 l 248.16 437.062 l 248.28 437.902 l 248.4 438.622 l 248.52 439.582 l 248.52 440.302 l 248.76 441.982 l 248.76 443.662 l 248.88 444.502 l 248.88 447.982 l 248.76 448.702 l 248.76 450.503 l 248.52 452.183 l 248.52 452.903 l 248.4 453.863 l 248.28 454.583 l 248.16 455.423 l 247.8 456.143 l 247.68 457.103 l 247.56 457.823 l 247.44 458.663 l 247.2 459.383 l 246.96 460.223 l 246.84 461.063 l 246.6 461.783 l 246.36 462.623 l 246.12 463.223 l 245.88 464.063 l 245.64 464.783 l 245.16 466.464 l 244.8 467.064 l 244.56 467.904 l 244.2 468.624 l 243.96 469.344 l 243.6 469.944 l 243.36 470.784 l 243 471.504 l W n q 12.12 0 0 -11.4007 236.76 444.9822 cm /Im5 Do Q Q q 236.76 433.555 12.375 -12.376 re W n 236.76 433.581 12.12 -12.121 re W n 243 471.504 m 242.28 470.064 l 241.8 469.464 l 241.56 468.624 l 241.2 468.024 l 240.84 467.184 l 240.6 466.464 l 240.24 465.744 l 240 464.904 l 239.76 464.303 l 239.4 463.463 l 239.16 462.863 l 239.04 462.023 l 238.8 461.183 l 238.56 460.463 l 238.32 459.623 l 238.08 458.903 l 237.72 456.383 l 237.48 455.783 l 237.36 454.823 l 237.24 453.983 l 237.12 453.263 l 237.12 452.303 l 237 451.583 l 236.88 450.623 l 236.88 449.903 l 236.76 449.062 l 236.76 443.902 l 236.88 443.062 l 236.88 442.222 l 237.12 440.542 l 237.12 439.822 l 237.24 438.862 l 237.36 438.142 l 237.48 437.302 l 237.72 436.342 l 237.84 435.742 l 238.08 434.061 l 238.32 433.221 l 238.56 432.621 l 238.8 431.781 l 239.04 431.061 l 239.16 430.221 l 239.4 429.381 l 239.76 428.661 l 240.24 427.221 l 240.6 426.381 l 240.84 425.661 l 241.56 424.221 l 241.8 423.621 l 242.28 422.901 l 243 421.461 l 243.6 422.781 l 243.96 423.501 l 244.2 424.221 l 244.56 424.941 l 244.8 425.661 l 245.16 426.261 l 245.4 427.101 l 245.64 427.701 l 245.88 428.541 l 246.36 429.981 l 246.6 430.821 l 246.84 431.541 l 246.96 432.381 l 247.2 432.981 l 247.44 433.822 l 247.56 434.542 l 247.68 435.502 l 247.8 436.222 l 248.16 437.062 l 248.28 437.902 l 248.4 438.622 l 248.52 439.582 l 248.52 440.302 l 248.76 441.982 l 248.76 443.662 l 248.88 444.502 l 248.88 447.982 l 248.76 448.702 l 248.76 450.503 l 248.52 452.183 l 248.52 452.903 l 248.4 453.863 l 248.28 454.583 l 248.16 455.423 l 247.8 456.143 l 247.68 457.103 l 247.56 457.823 l 247.44 458.663 l 247.2 459.383 l 246.96 460.223 l 246.84 461.063 l 246.6 461.783 l 246.36 462.623 l 246.12 463.223 l 245.88 464.063 l 245.64 464.783 l 245.16 466.464 l 244.8 467.064 l 244.56 467.904 l 244.2 468.624 l 243.96 469.344 l 243.6 469.944 l 243.36 470.784 l 243 471.504 l W n q 9.9164 0 0 -12.1208 237.8618 433.5815 cm /Im6 Do Q Q 0 0 0 RG 0.96 w 243 471.504 m 242.28 470.064 l 241.8 469.464 l 241.56 468.624 l 241.2 468.024 l 240.84 467.184 l 240.6 466.464 l 240.24 465.744 l 240 464.904 l 239.76 464.303 l 239.4 463.463 l 239.16 462.863 l 239.04 462.023 l 238.8 461.183 l 238.56 460.463 l 238.32 459.623 l 238.08 458.903 l 237.72 456.383 l 237.48 455.783 l 237.36 454.823 l 237.24 453.983 l 237.12 453.263 l 237.12 452.303 l 237 451.583 l 236.88 450.623 l 236.88 449.903 l 236.76 449.062 l 236.76 443.902 l 236.88 443.062 l 236.88 442.222 l 237.12 440.542 l 237.12 439.822 l 237.24 438.862 l 237.36 438.142 l 237.48 437.302 l 237.72 436.342 l 237.84 435.742 l 238.08 434.061 l 238.32 433.221 l 238.56 432.621 l 238.8 431.781 l 239.04 431.061 l 239.16 430.221 l 239.4 429.381 l 239.76 428.661 l 240.24 427.221 l 240.6 426.381 l 240.84 425.661 l 241.56 424.221 l 241.8 423.621 l 242.28 422.901 l 243 421.461 l 243.6 422.781 l 243.96 423.501 l 244.2 424.221 l 244.56 424.941 l 244.8 425.661 l 245.16 426.261 l 245.4 427.101 l 245.64 427.701 l 245.88 428.541 l 246.36 429.981 l 246.6 430.821 l 246.84 431.541 l 246.96 432.381 l 247.2 432.981 l 247.44 433.822 l 247.56 434.542 l 247.68 435.502 l 247.8 436.222 l 248.16 437.062 l 248.28 437.902 l 248.4 438.622 l 248.52 439.582 l 248.52 440.302 l 248.76 441.982 l 248.76 443.662 l 248.88 444.502 l 248.88 447.982 l 248.76 448.702 l 248.76 450.503 l 248.52 452.183 l 248.52 452.903 l 248.4 453.863 l 248.28 454.583 l 248.16 455.423 l 247.8 456.143 l 247.68 457.103 l 247.56 457.823 l 247.44 458.663 l 247.2 459.383 l 246.96 460.223 l 246.84 461.063 l 246.6 461.783 l 246.36 462.623 l 246.12 463.223 l 245.88 464.063 l 245.64 464.783 l 245.16 466.464 l 244.8 467.064 l 244.56 467.904 l 244.2 468.624 l 243.96 469.344 l 243.6 469.944 l 243.36 470.784 l 243 471.504 l 127.2 454.463 m 237.12 454.463 l 237.12 454.703 l 384.72 446.542 l 127.2 438.742 m 234.24 438.742 l 385.56 446.422 l S BT 14.04 0 0 14.0409 359.0396 489.505 Tm 0 0 0 rg -0.002 Tc -0.0025 Tw [(Point of)6.2( )-8.6(F)10.7(o)2.2(cus)]TJ ET 0 J 406.8 484.345 m 390.24 452.903 l S 386.64 455.183 m 386.64 445.702 l 394.2 451.223 l f* BT 20.04 0 0 20.0413 244.0796 191.4058 Tm -0.0003 Tc 0 Tw [(Astigma)4.8(ti)8.2(sm)]TJ -3.6886 -1.018 TD -0.0009 Tc -0.0017 Tw [(\(irr)4.9(egular)4.9( cor)4.9(n)-6.7(e)4.2(al curvatur)4.9(e)-0.4(\))]TJ ET 0.801 0.801 1 rg 0.5 0.5 0.5 RG 1 J 2.28 w 309.72 273.131 m 309.72 293.772 289.56 310.454 264.72 310.454 c 239.76 310.454 219.72 293.772 219.72 273.131 c 219.72 252.49 239.76 235.689 264.72 235.689 c 289.56 235.689 309.72 252.49 309.72 273.131 c b* 362.76 273.131 m 362.76 306.973 333.72 334.455 297.96 334.455 c 262.2 334.455 233.28 306.973 233.28 273.131 c 233.28 239.289 262.2 211.687 297.96 211.687 c 333.72 211.687 362.76 239.289 362.76 273.131 c b* 305.64 271.691 m 305.64 291.252 286.56 307.213 263.16 307.213 c 239.64 307.213 220.56 291.252 220.56 271.691 c 220.56 252.13 239.64 236.169 263.16 236.169 c 286.56 236.169 305.64 252.13 305.64 271.691 c f* q 238.32 297.571 12.13 -23.871 re W n 238.32 297.733 12 -23.642 re W n 244.56 297.733 m 243.84 296.413 l 243.48 295.693 l 243.24 294.853 l 242.88 294.253 l 242.4 293.412 l 242.16 292.692 l 241.8 291.972 l 241.56 291.132 l 241.32 290.532 l 240.96 289.692 l 240.72 289.092 l 240.6 288.252 l 240.36 287.532 l 239.88 285.852 l 239.64 285.132 l 239.28 282.612 l 239.04 282.012 l 238.92 281.052 l 238.8 280.332 l 238.68 279.492 l 238.68 278.652 l 238.56 277.811 l 238.44 276.851 l 238.44 276.131 l 238.32 275.291 l 238.32 270.131 l 238.44 269.291 l 238.44 268.451 l 238.68 266.771 l 238.68 266.051 l 238.8 265.091 l 238.92 264.491 l 239.04 263.531 l 239.28 262.69 l 239.4 261.97 l 239.64 260.29 l 239.88 259.45 l 240.12 258.85 l 240.36 258.01 l 240.6 257.29 l 240.72 256.45 l 240.96 255.61 l 241.32 254.89 l 241.8 253.45 l 242.16 252.61 l 242.4 252.01 l 242.88 251.17 l 243.24 250.45 l 243.48 249.85 l 244.56 247.69 l 245.16 249.01 l 245.52 249.73 l 245.76 250.45 l 246.12 251.17 l 246.36 251.89 l 246.72 252.49 l 246.96 253.33 l 247.2 253.93 l 247.44 254.77 l 247.92 256.21 l 248.16 257.05 l 248.4 257.77 l 248.52 258.61 l 248.76 259.21 l 249 260.05 l 249.24 261.73 l 249.36 262.451 l 249.6 263.291 l 249.72 264.131 l 249.84 264.851 l 249.96 265.811 l 249.96 266.531 l 250.2 268.211 l 250.2 269.891 l 250.32 270.731 l 250.32 274.211 l 250.2 275.051 l 250.2 276.731 l 249.96 278.411 l 249.96 279.132 l 249.84 280.092 l 249.72 280.812 l 249.6 281.652 l 249.36 282.372 l 249.24 283.332 l 249.12 284.052 l 249 284.892 l 248.76 285.732 l 248.52 286.452 l 248.4 287.292 l 248.16 288.012 l 247.92 288.852 l 247.68 289.452 l 247.44 290.292 l 247.2 291.012 l 246.72 292.692 l 246.36 293.292 l 246.12 294.133 l 245.76 294.853 l 245.52 295.573 l 245.16 296.293 l 244.92 297.013 l 244.56 297.733 l W n q 12 0 0 -23.6415 238.32 297.7327 cm /Im4 Do Q Q q 244.56 297.733 m 243.84 296.413 l 243.48 295.693 l 243.24 294.853 l 242.88 294.253 l 242.4 293.412 l 242.16 292.692 l 241.8 291.972 l 241.56 291.132 l 241.32 290.532 l 240.96 289.692 l 240.72 289.092 l 240.6 288.252 l 240.36 287.532 l 239.88 285.852 l 239.64 285.132 l 239.28 282.612 l 239.04 282.012 l 238.92 281.052 l 238.8 280.332 l 238.68 279.492 l 238.68 278.652 l 238.56 277.811 l 238.44 276.851 l 238.44 276.131 l 238.32 275.291 l 238.32 270.131 l 238.44 269.291 l 238.44 268.451 l 238.68 266.771 l 238.68 266.051 l 238.8 265.091 l 238.92 264.491 l 239.04 263.531 l 239.28 262.69 l 239.4 261.97 l 239.64 260.29 l 239.88 259.45 l 240.12 258.85 l 240.36 258.01 l 240.6 257.29 l 240.72 256.45 l 240.96 255.61 l 241.32 254.89 l 241.8 253.45 l 242.16 252.61 l 242.4 252.01 l 242.88 251.17 l 243.24 250.45 l 243.48 249.85 l 244.56 247.69 l 245.16 249.01 l 245.52 249.73 l 245.76 250.45 l 246.12 251.17 l 246.36 251.89 l 246.72 252.49 l 246.96 253.33 l 247.2 253.93 l 247.44 254.77 l 247.92 256.21 l 248.16 257.05 l 248.4 257.77 l 248.52 258.61 l 248.76 259.21 l 249 260.05 l 249.24 261.73 l 249.36 262.451 l 249.6 263.291 l 249.72 264.131 l 249.84 264.851 l 249.96 265.811 l 249.96 266.531 l 250.2 268.211 l 250.2 269.891 l 250.32 270.731 l 250.32 274.211 l 250.2 275.051 l 250.2 276.731 l 249.96 278.411 l 249.96 279.132 l 249.84 280.092 l 249.72 280.812 l 249.6 281.652 l 249.36 282.372 l 249.24 283.332 l 249.12 284.052 l 249 284.892 l 248.76 285.732 l 248.52 286.452 l 248.4 287.292 l 248.16 288.012 l 247.92 288.852 l 247.68 289.452 l 247.44 290.292 l 247.2 291.012 l 246.72 292.692 l 246.36 293.292 l 246.12 294.133 l 245.76 294.853 l 245.52 295.573 l 245.16 296.293 l 244.92 297.013 l 244.56 297.733 l W* n 0.996 0.996 0.996 rg 238.32 274.091 12 -2.88 re f Q q 238.32 271.042 12.065 -23.742 re W n 238.32 271.211 12 -23.522 re W n 244.56 297.733 m 243.84 296.413 l 243.48 295.693 l 243.24 294.853 l 242.88 294.253 l 242.4 293.412 l 242.16 292.692 l 241.8 291.972 l 241.56 291.132 l 241.32 290.532 l 240.96 289.692 l 240.72 289.092 l 240.6 288.252 l 240.36 287.532 l 239.88 285.852 l 239.64 285.132 l 239.28 282.612 l 239.04 282.012 l 238.92 281.052 l 238.8 280.332 l 238.68 279.492 l 238.68 278.652 l 238.56 277.811 l 238.44 276.851 l 238.44 276.131 l 238.32 275.291 l 238.32 270.131 l 238.44 269.291 l 238.44 268.451 l 238.68 266.771 l 238.68 266.051 l 238.8 265.091 l 238.92 264.491 l 239.04 263.531 l 239.28 262.69 l 239.4 261.97 l 239.64 260.29 l 239.88 259.45 l 240.12 258.85 l 240.36 258.01 l 240.6 257.29 l 240.72 256.45 l 240.96 255.61 l 241.32 254.89 l 241.8 253.45 l 242.16 252.61 l 242.4 252.01 l 242.88 251.17 l 243.24 250.45 l 243.48 249.85 l 244.56 247.69 l 245.16 249.01 l 245.52 249.73 l 245.76 250.45 l 246.12 251.17 l 246.36 251.89 l 246.72 252.49 l 246.96 253.33 l 247.2 253.93 l 247.44 254.77 l 247.92 256.21 l 248.16 257.05 l 248.4 257.77 l 248.52 258.61 l 248.76 259.21 l 249 260.05 l 249.24 261.73 l 249.36 262.451 l 249.6 263.291 l 249.72 264.131 l 249.84 264.851 l 249.96 265.811 l 249.96 266.531 l 250.2 268.211 l 250.2 269.891 l 250.32 270.731 l 250.32 274.211 l 250.2 275.051 l 250.2 276.731 l 249.96 278.411 l 249.96 279.132 l 249.84 280.092 l 249.72 280.812 l 249.6 281.652 l 249.36 282.372 l 249.24 283.332 l 249.12 284.052 l 249 284.892 l 248.76 285.732 l 248.52 286.452 l 248.4 287.292 l 248.16 288.012 l 247.92 288.852 l 247.68 289.452 l 247.44 290.292 l 247.2 291.012 l 246.72 292.692 l 246.36 293.292 l 246.12 294.133 l 245.76 294.853 l 245.52 295.573 l 245.16 296.293 l 244.92 297.013 l 244.56 297.733 l W n q 12 0 0 -23.5215 238.32 271.2111 cm /Im7 Do Q Q 0 0 0 RG 0.96 w 244.56 297.733 m 243.84 296.413 l 243.48 295.693 l 243.24 294.853 l 242.88 294.253 l 242.4 293.412 l 242.16 292.692 l 241.8 291.972 l 241.56 291.132 l 241.32 290.532 l 240.96 289.692 l 240.72 289.092 l 240.6 288.252 l 240.36 287.532 l 239.88 285.852 l 239.64 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\()-6.1(R)-2.6(K)-9.4(\))-6(,)]TJ -4.2289 -1.2048 TD -0.0021 Tc 0.0012 Tw [(Photor)-6.4(efr)-6.4(a)11.7(c)-8.1(ti)-9(ve Ker)-6.4(atec)-8.1(to)11.7(m)-12.5(y)-8.1( \()-6.4(P)2.2(R)-15(K)2.3(\))-6.4(,)-1.2( an)11.7(d Laser)-6.4(-)-18.5(A)2.2(ss)-8.1(i)-9(s)3.9(ted i)-9(n)-0.3( )12(s)-8.1(i)-9(tu Ker)-6.5(at)10.8(om)-12.5(i)-9(l)-9(e)11.7(us)-8.1(i)-9(s)3.9( \()-6.5(L)-0.3(AS)-9.8(IK\))-6.5(.)]TJ ET q 113.04 738 405 -632.04 re W n 1 J 0 j 114.96 142.843 396 594.038 re S EMC Q Q endstream endobj 66 0 obj << /ProcSet [/PDF /Text /ImageC ] /Font << /F1 4 0 R /F3 20 0 R /F7 24 0 R >> /XObject << /Im8 67 0 R /Im9 68 0 R >> /ExtGState << /GS4 34 0 R /GS7 69 0 R >> /Properties << /MC3 63 0 R >> >> endobj 70 0 obj << /FunctionType 0 /Domain [0 1] /Range [-1 1] /BitsPerSample 16 /Size [256] /Length 527 /Filter /FlateDecode >> stream H  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ ? endstream endobj 72 0 obj << /Length 8779 >> stream BT /F1 1 Tf 10 0 0 10 295.44 36.96 Tm 0 0 0 1 k /GS4 gs 0 Tc 0 Tw (4)Tj /F8 1 Tf 12 0 0 12 139.92 729.36 Tm 0.0175 Tc (METHODS)Tj /F1 1 Tf 11 0 0 11 54 703.3201 Tm 0.0031 Tc -0.0942 Tw [(1.)-880.5(A query of the FAAs Comprehensive Airman Infor-)]TJ 0 -1.1782 TD 0.0648 Tw (mation System \(CAIS\) for all airmen who applied for)Tj T* 0.0033 Tc -0.0288 Tw (airman medical certificates from 12/01/1992 to 12/31/)Tj 0 -1.1891 TD 0.0032 Tc 0.0113 Tw (1996 resulted in a database of 2,076,260 records. This)Tj 0 -1.1782 TD 0.0035 Tc 0.1462 Tw (database contained duplicate records for airmen that)Tj T* 0.0034 Tc 0.0993 Tw (had multiple certification exams during a single year,)Tj 0 -1.1891 TD -0.0358 Tw (incomplete airmen records, and records for airmen that)Tj 0 -1.1782 TD -0.0767 Tw (were pending or denied during the study period \(12/31/)Tj T* 0.0033 Tc -0.0201 Tw (1994 to 12/31/1996\). During this period, airmen were)Tj 0 -1.1891 TD 0.0034 Tc 0.1414 Tw (issued a medical certificate to perform the duties re-)Tj 0 -1.1782 TD 0.0033 Tc 0.0561 Tw (quired of one of the three classes of certification, pro-)Tj T* 0.1062 Tw (vided they met the medical standards for the applied)Tj 0 -1.1891 TD 0.0032 Tc -0.0114 Tw (class. The three classes of certification were valid under)Tj 0 -1.1782 TD 0.0035 Tc 0.0182 Tw (the following conditions:)Tj 2.7273 -1.1782 TD 0.0034 Tc -0.115 Tw [(a\))-629.3(A first-class certificate was valid for the month)]TJ -1.0909 -1.1891 TD 0.0035 Tc 0.0369 Tw (in which it was issued plus 6 months for activities)Tj 0 -1.1782 TD 0.0033 Tc -0.0772 Tw (requiring a first-class medical certificate, 12 months)Tj T* -0.1113 Tw (for activities requiring a second-class medical certifi-)Tj 0 -1.1891 TD 0.0035 Tc -0.041 Tw (cate, and 24 months for activities requiring a third-)Tj 0 -1.1782 TD 0.003 Tc 0.0106 Tw (class medical certificate \(4\).)Tj 1.0909 -1.1782 TD 0.16 Tw [(b\))-542.5(A second-class certificate was valid for the)]TJ -1.0909 -1.1891 TD 0.0033 Tc 0.0637 Tw (month in which it was issued plus 12 months for)Tj 0 -1.1782 TD 0.0034 Tc 0.14 Tw (activities requiring a second-class medical certifi-)Tj T* 0.0035 Tc -0.041 Tw (cate, and 24 months for activities requiring a third-)Tj 0 -1.1891 TD 0.003 Tc 0.0106 Tw (class medical certificate \(4\).)Tj 1.0909 -1.1782 TD 0.0232 Tc 0.1395 Tw [(c\))-598.6(A third-class certificate was valid for the)]TJ -1.0909 -1.1782 TD 0.0234 Tc -0.0389 Tw (month in which it was issued plus 24 months for)Tj 0 -1.1891 TD 0.0845 Tw (activities requiring a third-class medical certifi-)Tj 0 -1.1782 TD 0.0231 Tc -0.0839 Tw [(cate \(4\). \(Note: As of September 16, 1996, third-)]TJ T* -0.0335 Tw (class medical certificates for airmen < 40 years of)Tj 0 -1.1891 TD 0.0233 Tc -0.0577 Tw (age are valid for the month in which it was issued)Tj 0 -1.1782 TD 0.0436 Tw (plus 36 months. For third-class applicants)Tj /F9 1 Tf 17.4 0 TD 0.0737 Tc 0 Tw ( )Tj /F1 1 Tf 0.8945 0 TD 0.0232 Tc 0.0454 Tw [( 40)]TJ -18.2945 -1.1782 TD 0.0284 Tw (years of age, the duration of the medical certifi-)Tj 0 -1.1891 TD 0.0235 Tc 0.0015 Tw (cate is as in the original standard.\))Tj -1.6364 -1.1782 TD 0.003 Tc 0.0149 Tw [(2.)-880.6(The airmen records collected from the CAIS data-)]TJ T* 0.0032 Tc -0.0414 Tw (base were processed using a series of queries designed to)Tj 0 -1.1891 TD -0.0409 Tw (eliminate all but the last medical record for airmen who)Tj 0 -1.1782 TD 0.079 Tw (were active at the end of each year of the study. This)Tj T* -0.0077 Tc -0.1 Tw (procedure eliminated 396,741 records, leaving 1,679,519)Tj 0 -1.1891 TD 0.0033 Tc 0 Tw (active airman records for the study period.)Tj 0 -1.1782 TD -0.0939 Tw [(3.)-880.3(Airman records with medical certificates dated from)]TJ T* 0.0032 Tc 0.1591 Tw (12/01/1992 to 12/31/1994 were extracted from this)Tj 0 -1.1891 TD 0.0035 Tc 0.0505 Tw (data and saved as the 1994 Active Airman Population)Tj 0 -1.1782 TD 0.0031 Tc -0.0091 Tw (database. A similar process was followed to create data-)Tj T* 0.0841 Tw (bases for years 1995 and 1996. This process involved)Tj 0 -1.1891 TD 0.0034 Tc -0.0295 Tw (changing the exam dates in the queries appropriately to)Tj 0 -1.1782 TD -0.0113 Tw (extract the active airman records for individual years in)Tj T* -0.0046 Tw (the study period.)Tj 22.9091 57.9055 TD 0.0035 Tc -0.0286 Tw [(4.)-880.1(To construct the active airman database for airmen)]TJ 0 -1.1782 TD 0.0032 Tc -0.0267 Tw (with refractive surgery, each of the three Active Airman)Tj 0 -1.1891 TD 0.0033 Tc 0.0341 Tw (Population databases was queried for the FAA-specific)Tj 0 -1.1782 TD 0.0021 Tc -0.1 Tw (pathology codes 130 \(radial keratotomy\) and 5179 \(gen-)Tj T* 0.0031 Tc -0.063 Tw (eral eye pathology with surgical prefix\). Medical records)Tj 0 -1.1891 TD 0.0398 Tw (of airmen with pathology code 5179 were reviewed to)Tj 0 -1.1782 TD -0.0806 Tw (identify those airmen who had refractive surgery. \(Note:)Tj T* 0.0033 Tc -0.0747 Tw (The 5179 code is assigned to applicants with various eye)Tj 0 -1.1891 TD 0.0032 Tc -0.0932 Tw (surgeries, including refractive surgery.\) The airmen with)Tj 0 -1.1782 TD 0.0034 Tc 0.2371 Tw (pathology code 5179 identified as having refractive)Tj T* 0.003 Tc 0.0295 Tw (surgery and those with pathology code 130 were com-)Tj 0 -1.1891 TD 0.0036 Tc 0.0098 Tw (bined into Refractive Surgery Population databases for)Tj 0 -1.1782 TD 0.003 Tc 0.1414 Tw (each of the study years. There were a total of 7,753)Tj T* 0.0032 Tc 0.1104 Tw [(records for active airmen with refractive surgery con-)]TJ 0 -1.1891 TD 0.0034 Tc -0.003 Tw (tained in these databases.)Tj 0 -1.1782 TD 0.2273 Tw [(5.)-880.2(The records from 6,290 aviation accidents that)]TJ T* 0.003 Tc 0.1396 Tw (occurred during the study years 1994-1996 were ex-)Tj 0 -1.1891 TD -0.0088 Tc -0.1 Tw (tracted from the Accident/Incident Data Systems \(AIDS\),)Tj 0 -1.1782 TD 0.0035 Tc 0.0656 Tw (which is maintained by the FAAs Aviation Standards)Tj T* 0.0119 Tc 0.25 Tw (National Field Office, Operations Systems Branch)Tj 0 -1.1891 TD 0.0035 Tc -0.0746 Tw (\(AVN-124\). This information included pilot identifiers)Tj 0 -1.1782 TD -0.0216 Tw (\(i.e., pilot name, certificate number, and date of birth\).)Tj T* 0.0032 Tc -0.0874 Tw (Records for 810 accidents were unusable, due to the lack)Tj 0 -1.1891 TD 0.0036 Tc 0.1637 Tw (of any pilot identifiers, resulting in a total of 5,480)Tj 0 -1.1782 TD 0.0038 Tc 0.0091 Tw (accident records.)Tj T* 0.003 Tc 0.1018 Tw [(6.)-880.6(The 5,480 accident records were cross-referenced)]TJ 0 -1.1891 TD 0.0031 Tc -0.0335 Tw (with the 1,679,519 airmen medical records of the three)Tj 0 -1.1782 TD 0.0034 Tc 0.0394 Tw (Active Airman Population databases. This allowed the)Tj T* 0.0039 Tc 0.25 Tw (addition of information not included in the AIDS)Tj 0 -1.1891 TD 0.0034 Tc -0.033 Tw (database to the records of airmen involved in accidents,)Tj 0 -1.1782 TD 0.0031 Tc -0.0665 Tw (such as self-reported recent flight hours, class of medical)Tj T* 0.0034 Tc 0.2059 Tw [(certification, and pathology codes. A total of 1,283)]TJ 0 -1.1891 TD 0.0033 Tc 0.0074 Tw (accident records could not be matched, due to missing)Tj 0 -1.1782 TD 0.0034 Tc 0.2059 Tw (pilot certification numbers in the CAIS system. To)Tj T* 0.0033 Tc 0.0173 Tw (further identify accident records, cross-referencing was)Tj 0 -1.1891 TD 0.0034 Tc 0.011 Tw (performed using the pilots name, social security num-)Tj 0 -1.1782 TD 0.0035 Tc 0.2101 Tw (ber, and date of birth, resulting in a total accident)Tj T* -0.0319 Tw (database containing 4,197 records for the study period.)Tj 0 -1.1891 TD -0.0062 Tc -0.1 Tw [(7)-8.9(.)-889.8(Once cross-referencing and categorization were com-)]TJ 0 -1.1782 TD -0.0088 Tc (pleted, personal identifiers were stripped from the records,)Tj T* 0.0035 Tc -0.0708 Tw (and study numbers were assigned to maintain confiden-)Tj 0 -1.1891 TD 0.0033 Tc 0.1331 Tw (tiality. The remaining data included class of medical)Tj 0 -1.1782 TD -0.0732 Tw (certificate, age, and exposure \(flight hours for the last six)Tj T* 0.0032 Tc 0.2189 Tw (months\). Annual exposure hours were estimated by)Tj 0 -1.1891 TD -0.074 Tw (doubling each airmans self-reported flight hours for the)Tj 0 -1.1782 TD 0.0034 Tc 0.009 Tw (last six months.)Tj T* 0.0033 Tc 0.0053 Tw [(8.)-880.3(From the information collected in these databases,)]TJ 0 -1.1891 TD 0.0137 Tc 0.25 Tw (accident frequencies and accident rates \(accidents/)Tj 0 -1.1782 TD 0.0029 Tc 0.191 Tw (100,000 hours\) were calculated for the three classes)Tj T* 0.0033 Tc -0.019 Tw (\(first-, second-, and third-class\) of medical certification)Tj 0 -1.1891 TD -0.0506 Tw (issued for both airmen with refractive surgery and with-)Tj 0 -1.1782 TD -0.0031 Tw (out refractive surgery by year and for the study period.)Tj ET endstream endobj 73 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 33 0 R /F9 74 0 R >> /ExtGState << /GS4 34 0 R >> >> endobj 76 0 obj << /Length 8358 >> stream BT /F1 1 Tf 10 0 0 10 313.68 36 Tm 0 0 0 1 k /GS4 gs 0 Tc 0 Tw (5)Tj 11 0 0 11 336 690.36 Tm 0.0232 Tc 0.1228 Tw (The results of single-factor Analysis of Variance)Tj -1.0909 -1.1782 TD 0.023 Tc -0.0955 Tw (\(ANOVA\) are presented in Table 1. Although higher,)Tj 0 -1.1891 TD 0.0234 Tc 0.1416 Tw (the mean accident rates for airmen with refractive)Tj 0 -1.1782 TD 0.1572 Tw (surgery were not significantly different \(p > 0.05\))Tj T* -0.0629 Tw (compared to those airmen without refractive surgery.)Tj 0 -1.1891 TD 0.023 Tc 0.1386 Tw (The p-values for the total, first-class, second-class,)Tj 0 -1.1782 TD 0.0194 Tc -0.1249 Tw (and third-class populations equal 0.279, 0.259, 0.612,)Tj T* 0.0227 Tc -0.0018 Tw (and 0.282, respectively \(see Table 1\).)Tj /F8 1 Tf 12 0 0 12 404.04 573.36 Tm 0.0162 Tc 0 Tw (DISCUSSION)Tj /F1 1 Tf 11 0 0 11 336 547.32 Tm 0.0232 Tc -0.0674 Tw (Pilots with third-class medical certificates have the)Tj -1.0909 -1.1782 TD 0.0712 Tw [(highest aviation accident rates, while first-class cer-)]TJ T* 0.2106 Tw (tificate holders experienced the fewest number of)Tj 0 -1.1891 TD -0.0246 Tw (accidents, despite their considerably higher exposure)Tj 0 -1.1782 TD 0.0234 Tc 0.0266 Tw (\(i.e., recent flight hours\). Mitigating factors for this)Tj T* -0.081 Tw (difference between the classes of medical certification)Tj 0 -1.1891 TD -0.0074 Tw (may include the different types of aircraft flown and)Tj 0 -1.1782 TD 0.0214 Tc -0.1247 Tw (the flight operations performed by these airmen. First-)Tj T* 0.0233 Tc 0.1833 Tw (class certificate holders are primarily air transport)Tj 0 -1.1891 TD -0.1013 Tw (pilots who fly large, sophisticated aircraft. The major-)Tj 0 -1.1782 TD 0.0231 Tc -0.0114 Tw (ity of second-class certificate holders are commercial)Tj T* 0.0058 Tw (pilots who may fly air cargo, corporate, agricultural,)Tj 0 -1.1891 TD 0.2036 Tw (or small commuter aircraft. Third-class certificate)Tj 0 -1.1782 TD 0.0636 Tw (holders are primarily private pilots who fly for per-)Tj T* 0.0233 Tc 0.0792 Tw (sonal business or pleasure in light, privately owned)Tj 0 -1.1891 TD 0.0886 Tw (aircraft. Private pilots are required to have less fre-)Tj 0 -1.1782 TD 0.0237 Tc 0.0772 Tw (quent medical certification examinations, and their)Tj T* 0.0234 Tc 0.2116 Tw (medical standards are less stringent than first- or)Tj 0 -1.1891 TD 0.0229 Tc 0.1427 Tw (second-class medical certificate holders \(4.\). These)Tj 0 -1.1782 TD 0.0234 Tc -0.0995 Tw (pilots often do not have the level of training and flight)Tj T* -0.0481 Tw (experience as their air transport or commercial coun-)Tj 0 -1.1891 TD 0.0341 Tw (terparts. In addition, pilots with third-class medical)Tj 0 -1.1782 TD 0.023 Tc -0.1247 Tw (certificates tend to be older \(21\), their aircraft may not)Tj T* 0.0232 Tc -0.0284 Tw (be as carefully maintained, they usually fly without a)Tj 0 -1.1891 TD 0.0228 Tw (co-pilot, have fewer cockpit resources to assist them)Tj 0 -1.1782 TD 0.0236 Tc 0.1792 Tw (inflight, and they are often not instrument rated.)Tj T* 0.0232 Tc 0.0097 Tw (Finally, private pilots normally fly at lower altitudes)Tj 0 -1.1891 TD 0.0109 Tc -0.1247 Tw (where exposure to adverse weather conditions is greater,)Tj 0 -1.1782 TD 0.0213 Tc -0.125 Tw (and recovery time in an emergency situation is shorter.)Tj T* 0.0233 Tc -0.1129 Tw (Commercial pilots face similar limitations when com-)Tj 0 -1.1891 TD -0.0487 Tw (pared to air transport pilots, although the differences)Tj 0 -1.1782 TD 0.0231 Tc 0.003 Tw (are typically less substantial.)Tj 1.0909 -1.1782 TD 0.0233 Tc 0.0253 Tw (The accident rates for airmen with refractive sur-)Tj -1.0909 -1.1891 TD 0.0231 Tc -0.0384 Tw (gery were higher than those of non-refractive surgery)Tj 0 -1.1782 TD 0.0235 Tc -0.0234 Tw (airmen within each class of medical certification and)Tj T* 0.0233 Tc 0.0585 Tw (as a total group. Although their accident rates were)Tj 0 -1.1891 TD 0.0236 Tc -0.0392 Tw (higher, it is important to note that statistical analysis)Tj 0 -1.1782 TD 0.0223 Tc -0.125 Tw (found that no significant \(p > 0.05\) association existed)Tj -21.8182 56.7273 TD 0.0235 Tc 0.0477 Tw [(9.)-1383.8(Frequency counts reported in this study in-)]TJ -1.0909 -1.1782 TD 0.023 Tc -0.0435 Tw (clude all available airman records. However, to avoid)Tj 0 -1.1891 TD 0.0233 Tc 0.0046 Tw (skewing the accident rates, frequency counts for air-)Tj 0 -1.1782 TD 0.0231 Tc 0.048 Tw (men who had no self-reported hours for the last six)Tj T* 0.0233 Tc -0.0642 Tw (months were deleted prior to calculating the accident)Tj 0 -1.1891 TD 0.0176 Tw (rates. This action eliminated 1,742 \(22%\) of refrac-)Tj 0 -1.1782 TD 0.2467 Tw (tive surgery records and 396,667 \(24%\) of non-)Tj T* 0.0231 Tc 0.1455 Tw (refractive surgery records. From the perspective of)Tj 0 -1.1891 TD 0.0235 Tc -0.089 Tw (accident numbers, this action eliminated 395 \(9%\) of)Tj 0 -1.1782 TD -0.037 Tw (the accident and 398,014 \(24%\) of the non-accident)Tj T* 0.0225 Tc 0 Tw (records.)Tj /F8 1 Tf 12 0 0 12 162.96 534.36 Tm 0.0183 Tc (RESULTS)Tj /F1 1 Tf 11 0 0 11 84 508.32 Tm 0.0234 Tc -0.0353 Tw (The total airman population by class for the study)Tj -1.0909 -1.1782 TD 0.0231 Tc -0.0755 Tw (period \(1994-96\) is presented in Figure 3. The fewest)Tj T* 0.097 Tw (number of aviators were in first-class \(n=423,556\),)Tj 0 -1.1891 TD 0.0196 Tc -0.1249 Tw [(followed by second-class \(n=434,192\), and then third-)]TJ 0 -1.1782 TD 0.0233 Tc -0.0099 Tw (class \(n=815,771\) airman populations. Figure 4 pre-)Tj T* -0.0779 Tw (sents the refractive surgery population by class for the)Tj 0 -1.1891 TD 0.0236 Tc 0.0165 Tw (study period. As in the total airman population, the)Tj 0 -1.1782 TD 0.0234 Tc 0.2159 Tw (total refractive surgery population had the fewest)Tj T* 0.0232 Tc 0 Tw (number of aviators in first-class \(n=1,507\), followed)Tj 0 -1.1891 TD 0.0412 Tc 0.25 Tw (by second-class \(n=2,213\), and then third-class)Tj 0 -1.1782 TD 0.0235 Tc -0.0069 Tw (\(n=4,033\) airman populations.)Tj 1.0909 -1.1782 TD 0.189 Tw (Accident frequencies for the non-refractive and)Tj -1.0909 -1.1891 TD -0.1121 Tw (refractive surgery airman populations are presented in)Tj 0 -1.1782 TD 0.0232 Tc 0.1299 Tw (Figures 5 and 6, respectively. First-class airmen in)Tj T* 0.0553 Tw (both the non-refractive surgery \(n=815\) and refrac-)Tj 0 -1.1891 TD -0.0415 Tw (tive surgery \(n=6\) airman populations had the fewest)Tj 0 -1.1782 TD 0.1281 Tw (number of accidents. In the non-refractive surgery)Tj T* 0.0234 Tc 0.0163 Tw (population, second-class airmen had more accidents)Tj 0 -1.1891 TD 0.023 Tc -0.1061 Tw (\(n=1,712\) than third-class airmen \(n=1,639\) \(see Fig-)Tj 0 -1.1782 TD 0.0234 Tc 0.0597 Tw (ure 5\). In the refractive surgery airman population,)Tj T* 0.0232 Tc 0.1091 Tw (third-class airmen had more accidents \(n=13\) than)Tj 0 -1.1891 TD 0.023 Tc 0.0009 Tw (second-class airmen \(n=12\) \(see Figure 6\).)Tj 1.0909 -1.1782 TD 0.0234 Tc 0.0761 Tw (Figure 7 presents the accident rates for the non-)Tj -1.0909 -1.1782 TD -0.0985 Tw (refractive surgery and refractive surgery airman popu-)Tj 0 -1.1891 TD -0.1245 Tw (lations. The vertical bars are indicative of the 5 to 95%)Tj 0 -1.1782 TD 0.0232 Tc 0.0909 Tw (confidence interval for each group. Third-class air-)Tj T* 0.0279 Tw (men exhibited the highest accident rates while first-)Tj 0 -1.1891 TD 0.0142 Tc -0.1247 Tw (class certificate holders had the lowest aviation accident)Tj 0 -1.1782 TD 0.0187 Tc -0.1246 Tw (experience. Refractive surgery airmen exhibited higher)Tj T* 0.0233 Tc 0.1129 Tw (accident rates than their non-refractive surgery co-)Tj 0 -1.1891 TD 0.0231 Tc 0.0557 Tw (horts overall and for each class of medical certifica-)Tj 0 -1.1782 TD 0.0234 Tc -0.008 Tw (tion. 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0.199 0.492 rg 389.28 214.081 m 386.4 214.561 l 384.96 214.921 l 383.52 215.161 l 382.08 215.761 l 382.08 193.441 l 383.52 192.841 l 384.96 192.601 l 386.4 192.241 l 389.28 191.761 l 389.28 214.081 l b* 424.68 255.601 m 389.28 214.081 l 389.28 191.761 l 424.68 233.281 l 424.68 255.601 l b* 0.199 0.395 0.984 rg 389.28 213.961 m 387.84 214.321 l 384.96 214.801 l 383.52 215.161 l 382.08 215.641 l 424.68 255.601 l 389.28 213.961 l b* 0.398 0.398 0.5 rg 488.52 220.801 m 487.32 220.201 l 486.24 219.961 l 484.8 219.361 l 483.6 218.881 l 482.16 218.521 l 481.08 217.921 l 479.64 217.681 l 478.44 217.081 l 477 216.841 l 475.56 216.241 l 474.12 216.001 l 473.04 215.641 l 471.6 215.041 l 468.72 214.561 l 467.16 214.321 l 464.28 213.601 l 462.96 213.361 l 461.16 213.121 l 459.72 212.881 l 458.28 212.521 l 456.84 212.281 l 455.4 211.921 l 453.72 211.921 l 450.84 211.441 l 449.04 211.441 l 447.6 211.081 l 445.92 211.081 l 444.48 210.841 l 443.04 210.841 l 441.36 210.481 l 436.68 210.481 l 435 210.241 l 433.56 210.241 l 433.56 187.801 l 435 187.801 l 436.68 188.161 l 441.36 188.161 l 443.04 188.401 l 444.48 188.401 l 445.92 188.761 l 447.6 188.761 l 449.04 189.001 l 450.84 189.001 l 452.28 189.241 l 453.72 189.601 l 455.4 189.601 l 456.84 189.841 l 458.28 190.201 l 461.16 190.681 l 462.96 191.041 l 464.28 191.281 l 465.72 191.641 l 467.16 191.881 l 468.72 192.121 l 470.16 192.481 l 471.6 192.721 l 473.04 193.321 l 474.12 193.681 l 475.56 193.921 l 477 194.401 l 478.44 194.761 l 479.64 195.361 l 481.08 195.601 l 482.16 196.201 l 483.6 196.441 l 484.8 197.041 l 486.24 197.641 l 487.32 197.881 l 488.52 198.481 l 488.52 220.801 l b* 430.44 255.601 m 433.56 210.241 l 433.56 187.801 l 430.44 233.281 l 430.44 255.601 l b* 0.801 0.801 1 rg 488.52 220.921 m 487.32 220.201 l 486.24 219.961 l 484.8 219.361 l 483.6 218.881 l 482.16 218.521 l 481.08 217.921 l 479.64 217.681 l 478.44 217.081 l 477 216.841 l 475.56 216.241 l 474.12 216.001 l 473.04 215.641 l 471.6 215.041 l 468.72 214.561 l 467.28 214.201 l 465.84 213.961 l 464.28 213.601 l 462.96 213.361 l 461.16 213.121 l 459.72 212.761 l 458.28 212.521 l 456.96 212.281 l 455.4 211.921 l 453.72 211.921 l 452.28 211.681 l 450.84 211.321 l 449.16 211.321 l 447.72 211.081 l 445.92 211.081 l 444.48 210.841 l 443.04 210.841 l 441.36 210.481 l 436.68 210.481 l 435 210.241 l 433.56 210.241 l 430.44 255.601 l 488.52 220.921 l b* 0 0.5 0.5 rg 429.96 210.001 m 421.8 210.001 l 420.36 210.361 l 415.44 210.361 l 414 210.601 l 412.32 210.601 l 410.88 210.961 l 409.44 210.961 l 407.64 211.201 l 406.32 211.201 l 404.88 211.441 l 403.08 211.681 l 401.64 211.681 l 400.2 212.041 l 398.52 212.401 l 395.64 212.881 l 394.08 213.121 l 392.76 213.481 l 391.32 213.721 l 391.32 191.401 l 392.76 191.161 l 394.08 190.921 l 395.64 190.561 l 397.08 190.321 l 398.52 189.961 l 400.2 189.721 l 401.64 189.481 l 403.08 189.481 l 404.88 189.121 l 406.32 188.881 l 407.64 188.881 l 409.44 188.521 l 410.88 188.521 l 412.32 188.281 l 414 188.281 l 415.44 188.041 l 420.36 188.041 l 421.8 187.681 l 429.96 187.681 l 429.96 210.001 l b* 0 1 1 rg 429.96 210.001 m 421.8 210.001 l 420.36 210.241 l 415.44 210.241 l 414 210.601 l 412.32 210.601 l 410.88 210.841 l 409.44 210.841 l 407.64 211.081 l 406.32 211.081 l 404.88 211.441 l 403.08 211.681 l 401.64 211.681 l 400.2 212.041 l 398.52 212.281 l 397.08 212.521 l 395.64 212.881 l 394.08 213.121 l 392.76 213.481 l 391.32 213.721 l 426.72 255.361 l 429.96 210.001 l b* BT /F3 1 Tf 12 0 0 12 313.0797 189.1209 Tm 0 0 0 rg -0.0032 Tc 0 Tw [(Mis)-7.2(cod)-12.2(e)-0.7(s)]TJ 1.28 -1.2 TD -0.006 Tc (11%)Tj 10.13 0.17 TD 0.0005 Tc (PRK)Tj 0.05 -1.2 TD -0.006 Tc (10%)Tj 4.95 3.56 TD -0.002 Tc (RK)Tj -0.27 -1.2 TD -0.006 Tc (67%)Tj -9.21 -1.36 TD 0.0005 Tc (LASIK)Tj 0.78 -1.2 TD -0.006 Tc (7%)Tj -3.62 1.58 TD -0.0005 Tc [(Oth)-9.5(e)5.5(r)]TJ 0.61 -1.19 TD -0.006 Tc (2%)Tj -6.55 4.91 TD -0.0015 Tc [(Non)-10.5(-)]TJ -1.54 -1.19 TD -0.0019 Tc [(Retriev)-6(able)]TJ 1.97 -1.2 TD -0.006 Tc (3%)Tj 20.04 0 0 20.04 375.2396 309.8409 Tm 0.0004 Tc [(19)5.5(97-19)5.5(98)]TJ ET 0.277 0.004 0.492 rg 164.88 329.881 m 164.64 330.721 l 164.64 331.681 l 164.4 332.281 l 164.16 333.121 l 164.16 333.721 l 163.8 334.681 l 163.8 337.561 l 163.8 312.481 l 164.16 311.641 l 164.16 311.041 l 164.4 310.081 l 164.64 309.481 l 164.64 308.641 l 164.88 307.681 l 164.88 329.881 l b* 340.92 337.561 m 340.92 336.121 l 340.56 335.281 l 340.56 333.721 l 340.32 333.121 l 340.32 332.281 l 339.96 331.681 l 339.72 330.721 l 339.48 329.881 l 339.12 329.281 l 338.88 328.321 l 338.52 327.721 l 338.28 326.881 l 337.92 326.281 l 337.32 325.321 l 336.96 324.841 l 336.48 323.881 l 336.12 323.281 l 335.52 322.441 l 334.92 321.841 l 334.32 320.881 l 333.72 320.401 l 333.12 319.681 l 332.52 318.841 l 332.04 318.241 l 331.08 317.641 l 330.48 316.681 l 329.88 316.081 l 329.04 315.481 l 328.08 315.001 l 327.48 314.041 l 326.64 313.441 l 325.68 312.841 l 324.84 312.241 l 323.88 311.641 l 322.2 310.441 l 321.24 309.601 l 320.04 309.001 l 319.2 308.401 l 318 308.161 l 317.04 307.441 l 315.84 306.841 l 315 306.241 l 313.8 305.761 l 312.6 305.161 l 311.4 304.801 l 310.44 304.201 l 309.36 303.601 l 308.16 303.001 l 306.96 302.761 l 305.52 302.161 l 304.2 301.801 l 303 301.201 l 301.92 300.841 l 300.6 300.361 l 299.16 300.001 l 297.96 299.761 l 296.52 299.161 l 295.32 298.801 l 293.76 298.561 l 292.68 297.961 l 291.12 297.601 l 289.68 297.361 l 288.48 297.001 l 286.92 296.761 l 285.48 296.401 l 283.92 296.161 l 282.48 295.801 l 281.04 295.561 l 279.84 295.561 l 279.84 273.481 l 281.04 273.481 l 282.48 273.721 l 283.92 274.081 l 285.48 274.321 l 286.92 274.681 l 288.48 274.921 l 289.68 275.281 l 291.12 275.521 l 292.68 275.881 l 293.76 276.361 l 295.32 276.721 l 296.52 277.081 l 297.96 277.681 l 299.16 277.921 l 300.6 278.281 l 301.92 278.881 l 303 279.121 l 304.2 279.721 l 305.52 279.961 l 306.96 280.681 l 308.16 280.921 l 309.36 281.521 l 310.44 282.121 l 311.4 282.721 l 312.6 282.961 l 313.8 283.561 l 315 284.281 l 315.84 284.761 l 317.04 285.361 l 318 285.961 l 319.2 286.321 l 320.04 286.921 l 321.24 287.521 l 322.2 288.361 l 323.88 289.561 l 324.84 290.161 l 325.68 290.761 l 326.64 291.361 l 327.48 291.961 l 328.08 292.921 l 329.04 293.521 l 329.88 294.001 l 330.48 294.601 l 331.08 295.561 l 332.04 296.161 l 332.52 296.761 l 333.12 297.601 l 334.32 298.801 l 334.92 299.761 l 335.52 300.361 l 336.12 301.201 l 336.48 301.801 l 336.96 302.761 l 337.32 303.241 l 337.92 304.201 l 338.28 304.801 l 338.52 305.761 l 338.88 306.241 l 339.12 307.201 l 339.48 307.801 l 339.72 308.641 l 339.96 309.601 l 340.32 310.201 l 340.32 311.041 l 340.56 311.641 l 340.56 313.081 l 340.92 314.041 l 340.92 337.561 l b* 252.24 337.561 m 165.24 329.881 l 165.24 307.681 l 252.24 315.481 l 252.24 337.561 l b* 252.24 337.561 m 279.84 295.561 l 279.84 273.481 l 252.24 315.481 l 252.24 337.561 l b* 0.559 0.004 0.988 rg 165 329.761 m 164.76 330.721 l 164.76 331.681 l 164.4 332.161 l 164.16 333.121 l 164.16 333.721 l 163.8 334.681 l 163.8 340.921 l 164.16 341.521 l 164.16 342.361 l 164.4 342.961 l 164.76 343.921 l 164.76 344.761 l 165 345.361 l 165.24 346.201 l 165.6 346.921 l 165.84 347.761 l 166.44 348.361 l 166.8 349.201 l 167.04 349.801 l 167.64 350.761 l 168 351.361 l 168.6 352.201 l 169.2 352.801 l 169.44 353.761 l 170.04 354.241 l 170.64 354.841 l 171.24 355.801 l 172.2 356.401 l 172.68 357.241 l 173.28 357.841 l 174.24 358.441 l 174.84 359.161 l 176.28 360.601 l 177.24 361.201 l 178.08 361.801 l 179.04 362.641 l 179.52 363.241 l 180.48 363.841 l 181.68 364.441 l 182.52 365.041 l 184.44 366.241 l 185.52 366.841 l 186.48 367.441 l 187.68 368.041 l 188.52 368.641 l 189.72 369.241 l 190.68 369.481 l 191.88 370.081 l 192.96 370.681 l 194.28 371.401 l 195.36 371.641 l 197.76 372.841 l 198.96 373.081 l 200.16 373.681 l 201.36 374.041 l 202.8 374.641 l 204.12 374.881 l 205.2 375.481 l 206.76 375.841 l 207.96 376.081 l 209.4 376.681 l 210.6 377.041 l 212.16 377.281 l 213.6 377.641 l 214.8 377.881 l 216.24 378.241 l 217.8 378.481 l 219 378.841 l 220.44 379.081 l 222 379.321 l 223.44 379.681 l 225 380.041 l 226.44 380.281 l 227.88 380.281 l 229.44 380.641 l 230.88 380.881 l 232.32 380.881 l 233.88 381.241 l 235.32 381.481 l 238.32 381.481 l 239.76 381.841 l 243.12 381.841 l 244.68 382.081 l 260.04 382.081 l 261.6 381.841 l 264.6 381.841 l 266.04 381.481 l 269.04 381.481 l 270.84 381.241 l 272.28 380.881 l 273.84 380.881 l 275.28 380.641 l 276.84 380.281 l 278.28 380.281 l 279.72 380.041 l 281.04 379.681 l 282.48 379.321 l 283.92 379.081 l 285.48 378.841 l 286.92 378.481 l 288.48 378.241 l 289.56 377.881 l 291.12 377.641 l 292.56 377.281 l 293.76 377.041 l 295.32 376.681 l 296.52 376.081 l 297.96 375.841 l 299.16 375.481 l 300.6 374.881 l 301.92 374.641 l 303 374.041 l 304.2 373.681 l 305.4 373.081 l 306.84 372.841 l 308.16 372.241 l 309.36 371.641 l 310.44 371.401 l 311.4 370.681 l 313.8 369.481 l 315 369.241 l 315.84 368.641 l 317.04 368.041 l 318 367.441 l 319.2 366.841 l 320.04 366.241 l 321.24 365.641 l 322.2 365.041 l 323.88 363.841 l 324.84 363.241 l 325.68 362.641 l 326.64 361.801 l 327.48 361.201 l 328.08 360.601 l 329.04 360.001 l 329.88 359.161 l 330.48 358.441 l 331.08 357.841 l 332.04 357.241 l 332.52 356.401 l 333.12 355.801 l 333.72 354.841 l 334.32 354.241 l 334.92 353.761 l 335.52 352.801 l 336.12 352.201 l 336.48 351.361 l 336.96 350.761 l 337.32 349.801 l 337.92 349.201 l 338.28 348.361 l 338.52 347.761 l 338.88 346.921 l 339.12 346.201 l 339.48 345.361 l 339.72 344.761 l 339.96 343.921 l 340.32 342.961 l 340.32 342.361 l 340.56 341.521 l 340.56 339.961 l 340.92 339.001 l 340.92 336.121 l 340.56 335.161 l 340.56 333.721 l 340.32 333.121 l 340.32 332.161 l 339.96 331.681 l 339.48 329.761 l 339.12 329.281 l 338.88 328.321 l 338.52 327.721 l 338.28 326.761 l 337.92 326.281 l 337.32 325.321 l 336.96 324.721 l 336.48 323.881 l 336.12 323.281 l 335.52 322.321 l 334.92 321.721 l 334.32 320.881 l 333.12 319.681 l 332.52 318.841 l 332.04 318.121 l 331.08 317.521 l 330.48 316.681 l 329.88 316.081 l 329.04 315.481 l 328.08 314.881 l 327.48 314.041 l 326.64 313.441 l 325.68 312.841 l 324.84 312.241 l 323.88 311.641 l 322.2 310.441 l 321.24 309.481 l 320.04 308.881 l 319.2 308.281 l 318 308.041 l 317.04 307.441 l 315.84 306.841 l 315 306.241 l 312.6 305.041 l 311.4 304.681 l 310.44 304.201 l 309.36 303.601 l 308.16 303.001 l 306.84 302.641 l 305.4 302.041 l 304.2 301.681 l 303 301.201 l 301.92 300.841 l 300.6 300.241 l 299.16 300.001 l 297.96 299.641 l 296.52 299.041 l 295.32 298.801 l 293.76 298.441 l 292.56 297.841 l 291.12 297.601 l 289.56 297.241 l 288.48 297.001 l 286.92 296.641 l 285.48 296.401 l 283.92 296.041 l 282.48 295.801 l 281.04 295.441 l 279.72 295.441 l 252.36 337.561 l 165 329.761 l b* 0.5 0.5 0.5 rg 156.36 322.441 m 156.12 323.041 l 155.52 323.881 l 155.16 324.481 l 154.92 325.321 l 154.56 326.041 l 154.56 303.841 l 154.92 303.241 l 155.16 302.281 l 155.52 301.681 l 156.12 300.841 l 156.36 300.241 l 156.36 322.441 l b* 241.92 333.721 m 156.36 322.441 l 156.36 300.241 l 241.92 311.641 l 241.92 333.721 l b* 1 1 1 rg 156.36 322.321 m 156 322.921 l 155.4 323.881 l 155.16 324.481 l 154.92 325.321 l 154.56 325.921 l 241.92 333.721 l 156.36 322.321 l b* 0.5 0 0.5 rg 199.56 293.161 m 198 293.521 l 196.92 294.121 l 195.36 294.361 l 194.16 294.601 l 192.96 295.201 l 191.52 295.561 l 190.32 296.161 l 189.12 296.521 l 187.92 297.001 l 186.72 297.361 l 183.12 299.161 l 181.92 299.401 l 180.72 300.001 l 179.88 300.601 l 178.68 301.201 l 177.72 301.801 l 176.64 302.401 l 175.68 302.761 l 174.48 303.361 l 173.64 303.841 l 172.68 304.801 l 171.84 305.401 l 170.64 306.001 l 169.8 306.601 l 169.08 307.201 l 167.4 308.401 l 166.44 309.241 l 165.84 309.841 l 165 310.441 l 162.84 312.601 l 162.24 313.081 l 161.4 314.041 l 160.2 315.241 l 159.6 316.081 l 159.24 316.681 l 158.64 317.641 l 158.04 318.241 l 157.8 319.081 l 157.2 319.681 l 156.96 320.641 l 156.96 298.561 l 157.2 297.601 l 157.8 297.001 l 158.04 296.161 l 158.64 295.561 l 159.24 294.601 l 159.6 294.121 l 160.2 293.161 l 165 288.361 l 165.84 287.761 l 166.44 287.281 l 167.4 286.321 l 169.08 285.121 l 169.8 284.521 l 170.64 283.921 l 171.84 283.321 l 172.68 282.721 l 173.64 281.881 l 174.48 281.281 l 175.68 280.681 l 176.64 280.321 l 177.72 279.721 l 178.68 279.121 l 179.88 278.641 l 180.72 277.921 l 181.92 277.321 l 183.12 277.081 l 186.72 275.281 l 187.92 275.041 l 189.12 274.321 l 190.32 274.081 l 191.52 273.481 l 192.96 273.241 l 194.16 272.641 l 195.36 272.281 l 196.92 272.041 l 198 271.321 l 199.56 271.081 l 199.56 293.161 l b* 242.52 332.041 m 199.56 293.161 l 199.56 271.081 l 242.52 309.961 l 242.52 332.041 l b* 1 0 1 rg 199.56 293.161 m 198.12 293.401 l 196.92 294.001 l 195.36 294.361 l 194.28 294.601 l 192.96 295.201 l 191.52 295.561 l 190.32 296.161 l 189.12 296.401 l 187.92 297.001 l 186.72 297.241 l 185.52 297.961 l 183.12 299.161 l 181.92 299.401 l 180.84 300.001 l 179.88 300.601 l 178.68 301.201 l 177.84 301.801 l 176.64 302.401 l 175.68 302.641 l 174.48 303.241 l 173.64 303.841 l 172.68 304.801 l 171.84 305.401 l 170.64 306.001 l 169.8 306.601 l 169.08 307.201 l 167.4 308.401 l 166.44 309.241 l 165.84 309.841 l 165 310.441 l 162.84 312.601 l 162.24 313.081 l 161.4 314.041 l 160.2 315.241 l 159.6 316.081 l 159.24 316.681 l 158.64 317.641 l 158.04 318.241 l 157.8 319.081 l 157.2 319.681 l 156.96 320.641 l 242.52 332.041 l 199.56 293.161 l b* 0.102 0.199 0.492 rg 209.4 290.761 m 207.96 291.001 l 206.76 291.361 l 205.2 291.601 l 203.76 292.201 l 202.56 292.441 l 202.56 270.481 l 203.76 270.121 l 205.2 269.521 l 206.76 269.161 l 207.96 268.921 l 209.4 268.561 l 209.4 290.761 l b* 245.52 331.321 m 209.4 290.761 l 209.4 268.561 l 245.52 309.241 l 245.52 331.321 l b* 0.199 0.395 0.984 rg 209.4 290.761 m 207.96 291.001 l 206.76 291.361 l 205.2 291.601 l 203.76 292.201 l 202.56 292.441 l 245.52 331.321 l 209.4 290.761 l b* 0 0.5 0.5 rg 220.44 288.961 m 218.88 289.201 l 217.44 289.201 l 215.88 289.561 l 214.44 289.801 l 213 290.041 l 211.8 290.401 l 210.24 290.761 l 210.24 268.561 l 211.8 268.321 l 213 268.081 l 214.44 267.721 l 215.88 267.481 l 217.44 267.121 l 218.88 267.121 l 220.44 266.881 l 220.44 288.961 l b* 246.36 331.321 m 220.44 288.961 l 220.44 266.881 l 246.36 309.241 l 246.36 331.321 l b* 0 1 1 rg 220.44 288.961 m 218.88 289.321 l 217.44 289.321 l 215.88 289.561 l 214.44 289.921 l 213 290.161 l 211.8 290.521 l 210.24 290.761 l 246.36 331.321 l 220.44 288.961 l b* 0.398 0.398 0.5 rg 276.12 288.961 m 274.68 288.601 l 273.24 288.361 l 271.68 288.121 l 270.24 288.121 l 268.8 287.761 l 267.24 287.761 l 265.44 287.521 l 264 287.521 l 262.44 287.161 l 261 287.161 l 259.56 286.921 l 254.76 286.921 l 253.2 286.561 l 243.96 286.561 l 242.52 286.921 l 238.08 286.921 l 236.28 287.161 l 234.84 287.161 l 233.28 287.521 l 231.84 287.521 l 230.4 287.761 l 228.84 287.761 l 227.4 288.121 l 225.84 288.121 l 224.4 288.361 l 222.96 288.601 l 222.96 266.521 l 224.4 266.281 l 225.84 265.921 l 227.4 265.921 l 228.84 265.681 l 230.4 265.681 l 231.84 265.441 l 233.28 265.441 l 234.84 265.081 l 236.28 265.081 l 238.08 264.841 l 242.52 264.841 l 243.96 264.481 l 253.2 264.481 l 254.76 264.841 l 259.56 264.841 l 261 265.081 l 262.44 265.081 l 264 265.441 l 265.44 265.441 l 267.24 265.681 l 268.8 265.681 l 270.24 265.921 l 271.68 265.921 l 273.24 266.281 l 274.68 266.521 l 276.12 266.881 l 276.12 288.961 l b* 0.801 0.801 1 rg 276.12 288.961 m 273.24 288.481 l 271.68 288.121 l 270.24 288.121 l 268.8 287.881 l 267.24 287.881 l 265.44 287.521 l 264 287.521 l 262.44 287.281 l 261 287.281 l 259.56 286.921 l 254.76 286.921 l 253.2 286.561 l 243.96 286.561 l 242.52 286.921 l 238.08 286.921 l 236.28 287.281 l 234.84 287.281 l 233.28 287.521 l 231.84 287.521 l 230.4 287.881 l 228.84 287.881 l 227.4 288.121 l 225.84 288.121 l 224.4 288.481 l 222.96 288.721 l 248.88 331.081 l 276.12 288.961 l b* BT 12 0 0 12 131.9997 266.7609 Tm 0 0 0 rg -0.0032 Tc [(Mis)-7.2(cod)-12.2(e)-0.7(s)]TJ 1.28 -1.2 TD -0.006 Tc (13%)Tj 8.44 -0.29 TD 0.0005 Tc (PRK)Tj 0.05 -1.2 TD -0.006 Tc (10%)Tj 4.38 2.36 TD -0.002 Tc (RK)Tj -0.27 -1.19 TD -0.006 Tc (73%)Tj -7.75 0.12 TD 0.0005 Tc (LASIK)Tj 0.78 -1.2 TD -0.006 Tc (2%)Tj -3.51 1.66 TD -0.0005 Tc [(Oth)-9.5(e)5.5(r)]TJ 0.61 -1.2 TD -0.006 Tc (1%)Tj -5.56 5.3 TD -0.0015 Tc [(Non)-10.5(-)]TJ -1.55 -1.19 TD -0.0019 Tc [(Retriev)-6(able)]TJ 1.97 -1.2 TD -0.006 Tc (1%)Tj 20.04 0 0 20.04 202.3196 386.5209 Tm 0.0004 Tc [(19)5.5(94-19)5.5(96)]TJ ET q 87 738 456 -624 re W n 0 j 1.44 w 88.92 146.761 449.16 273.72 re S Q 1 1 1 rg 88.32 737.281 449.4 -247.08 re f q 87 738 456 -624 re W n 0 j 0.12 w 88.2 490.201 449.52 247.2 re S Q 153.96 718.801 379.32 -173.04 re f q 154.08 573.961 379.2 0.24 re W n 0 j 0.12 w 153.96 574.201 m 533.28 574.201 l S Q q 154.08 603.241 379.2 0.24 re W n 0 j 0.12 w 153.96 603.481 m 533.28 603.481 l S Q q 154.08 631.681 379.2 0.24 re W n 0 j 0.12 w 153.96 631.921 m 533.28 631.921 l S Q q 154.08 660.841 379.2 0.24 re W n 0 j 0.12 w 153.96 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127.9197 676.0809 Tm 0 Tc 0 Tw (s)Tj ET Q 111 529.201 m 533.28 529.201 l 111 497.761 m 533.28 497.761 l 153.96 545.761 m 533.28 545.761 l 111 529.201 m 111 497.761 l 153.96 545.761 m 153.96 497.761 l 249.12 545.761 m 249.12 497.761 l 343.56 545.761 m 343.56 497.761 l 438.84 545.761 m 438.84 497.761 l 533.28 545.761 m 533.28 497.761 l S q 0.9772 0 0 -1.0233 0 0 cm 0.602 0.602 1 rg 0.732 w 116.531 -505.417 5.157 -5.16 re B* Q BT /F7 1 Tf 8.5879 0 0 8.9911 121.7997 517.4409 Tm 0.032 Tc 0 Tw [(Non)15.1(RS)]TJ 8.2581 0.0801 TD 0.0309 Tc [(0)14(.)57.4(41)-9082.5(2.)71.4(71)-8998.7(4.)57.4(7)14(3)-9082.5(2.)57.4(62)]TJ ET q 111.84 512.521 420.72 0.24 re W n 111 512.761 m 533.28 512.761 l S Q q 0.9772 0 0 -1.0233 0 0 cm 0.602 0.199 0.398 rg 0.732 w 116.531 -490.056 5.157 -5.16 re B* Q BT 8.5879 0 0 8.9911 121.7997 501.7209 Tm 0.0325 Tc (RS)Tj 8.2581 0.0801 TD 0.0309 Tc [(0)14(.)57.4(88)-9082.5(3.)71.4(41)-8998.7(7.)57.4(2)14(9)-9082.5(3.)57.4(86)]TJ -0.6707 3.6703 TD 0.0869 Tc -0.1134 Tw [(C)54.4(l)71.4(a)56(ss I)-7627.7(C)54.3(l)57.4(a)70(ss I)113.4(I)-7208.5(C)54.4(l)57.4(a)56(s)14(s I)113.4(I)113.4(I)-7963.1(T)111(o)56(t)113.4(a)70(l)]TJ ET q 87 738 456 -624 re W n 88.2 490.201 449.52 247.2 re S EMC Q Q endstream endobj 105 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F3 20 0 R /F7 24 0 R >> /ExtGState << /GS4 34 0 R /GS11 106 0 R >> /Properties << /MC7 102 0 R >> >> endobj 107 0 obj << /FunctionType 0 /Domain [0 1] /Range [-1 1] /BitsPerSample 16 /Size [256] /Length 527 /Filter /FlateDecode >> stream H  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ ? endstream endobj 109 0 obj << /Length 8477 >> stream BT /F1 1 Tf 10 0 0 10 292.92 36.96 Tm 0 0 0 1 k /GS4 gs 0.02 Tc 0 Tw (10)Tj 11 0 0 11 54 729.36 Tm 0.0234 Tc 0.0243 Tw (between airmen with refractive surgery and aviation)Tj 0 -1.1782 TD 0.0033 Tw (accidents. The higher accident rates for airmen with)Tj 0 -1.1891 TD 0.0232 Tc -0.0671 Tw (refractive surgery may be due to a number of contrib-)Tj 0 -1.1782 TD 0.0235 Tc 0.0719 Tw (uting factors. These factors include irregularities in)Tj T* -0.0242 Tw (the data or data acquisition process, social-economic)Tj 0 -1.1891 TD 0.0233 Tc 0.079 Tw (factors not shared by both groups, or a diminished)Tj 0 -1.1782 TD 0.0242 Tw (physiological capability common to airmen with re-)Tj T* 0.0229 Tc -0.0046 Tw (fractive surgery.)Tj 1.0909 -1.1891 TD 0.0235 Tc 0.0694 Tw (To investigate the possibility of factors that may)Tj -1.0909 -1.1782 TD 0.0233 Tc -0.0901 Tw (have linked these accidents, the National Transporta-)Tj T* 0.1312 Tw (tion Safety Board reports were reviewed for all 31)Tj 0 -1.1891 TD 0.1418 Tw (accidents involving airmen with refractive surgery.)Tj 0 -1.1782 TD -0.0884 Tw (These reports revealed that approximately 90% of the)Tj T* -0.05 Tw (accidents involved general aviation \(Federal Aviation)Tj 0 -1.1891 TD 0.0236 Tc -0.1109 Tw (Regulations, Part 91\). Environmental conditions that)Tj 0 -1.1782 TD 0.0234 Tc 0.0531 Tw (existed during these accidents included: 84% visual)Tj T* 0.1745 Tw (meteorological conditions, 71% daylight, 94% no)Tj 0 -1.1891 TD 0.0237 Tc -0.0673 Tw (precipitation, and 94% unrestricted visibility. Phases)Tj 0 -1.1782 TD 0.0233 Tc -0.0766 Tw (of flight included: taxiing \(n=1\), takeoff \(n=5\), cruise)Tj T* 0.0231 Tc 0.2263 Tw (\(n=8\), approach \(n=2\), landing \(n=8\), emergency)Tj 0 -1.1891 TD 0.0101 Tc -0.125 Tw (landing \(n=1\), maneuvering \(n=5\), and hovering \(n=1\).)Tj 0 -1.1782 TD 0.0236 Tc 0.0022 Tw (The information obtained from the accident reports)Tj T* 0.0233 Tc 0.1435 Tw (was unremarkable, except that the majority of the)Tj 0 -1.1891 TD 0.034 Tc 0.2499 Tw [(accidents occurred during optimal visibility and)]TJ 0 -1.1782 TD 0.0233 Tc 0.1582 Tw (weather conditions. The report narratives revealed)Tj T* -0.0753 Tw (only three references to visual difficulties. One report)Tj 0 -1.1891 TD 0.0235 Tc -0.0508 Tw (described the aircraft striking an unattended baggage)Tj 0 -1.1782 TD 0.1494 Tw (cart while taxiing at night on a poorly-lit parking)Tj T* 0.1324 Tw (ramp. A second accident was a midair collision in)Tj 0 -1.1891 TD 0.0232 Tc -0.1121 Tw (which both pilots reportedly failed to see-and-avoid)Tj 0 -1.1782 TD 0.0051 Tw (one another. \(Note: The other pilot involved in this)Tj T* 0.0591 Tw (accident did not have refractive surgery.\) The third)Tj 0 -1.1891 TD 0.0235 Tc -0.0363 Tw (accident occurred as the pilot attempted to land on a)Tj 0 -1.1782 TD 0.0232 Tc -0.054 Tw (section of beach that he thought was wet sand, which)Tj T* 0.085 Tw (was actually a 6 to 8-inch deep pool of water. The)Tj 0 -1.1891 TD 0.0235 Tc -0.1046 Tw (perceptual difficulties encountered during these three)Tj 0 -1.1782 TD 0.0233 Tc -0.0352 Tw [(mishaps could not be directly associated to the pilots)]TJ T* -0.0045 Tw (having refractive surgery with any certainty.)Tj 1.0909 -1.1891 TD -0.0943 Tw (Based on its growing popularity in the general U.S.)Tj -1.0909 -1.1782 TD 0.0237 Tc 0.1007 Tw (population \(22,23,24\), it is anticipated that an in-)Tj T* 0.0232 Tc -0.052 Tw (creasing number of laser refractive procedures will be)Tj 0 -1.1891 TD 0.0234 Tc 0.0455 Tw (performed on civil pilots. As mentioned previously,)Tj 0 -1.1782 TD 0.0232 Tc 0.0883 Tw (1.3 million laser procedures were performed in the)Tj T* -0.1209 Tw (U.S. during the year 2000 \(5\), and there is an expected)Tj 0 -1.1891 TD 0.023 Tc 0.0627 Tw (growth rate of 35-40% over the next five years \(6\).)Tj 0 -1.1782 TD -0.0483 Tw (This trend has already been observed in the compari-)Tj T* 0.0234 Tc 0.2045 Tw (son of two data sets of refractive surgery in civil)Tj 0 -1.1891 TD 0.0231 Tc 0.1585 Tw (airmen for the periods 1994-96 and 1997-98 \(see)Tj 0 -1.1782 TD -0.0778 Tw (Figure 8\). The total number of airmen with refractive)Tj T* 0.0697 Tw (surgery increased by approximately 37%, and there)Tj 0 -1.1891 TD 0.0235 Tc 0.2364 Tw (was a change in the distribution of the types of)Tj 22.9091 59.0945 TD 0.021 Tc -0.125 Tw (refractive procedures. The percentage of RK decreased)Tj 0 -1.1782 TD 0.0233 Tc 0.0687 Tw (from 73 to 67%, PRK remained at 10%, while the)Tj 0 -1.1891 TD 0.1015 Tw (percentage of LASIK procedures more than tripled)Tj 0 -1.1782 TD 0.0235 Tc -0.0016 Tw (from 2% to 7%.)Tj 1.0909 -1.1782 TD -0.1244 Tw (RK is the most prevalent refractive procedure in the)Tj -1.0909 -1.1891 TD -0.122 Tw (airman population during the study period. However,)Tj 0 -1.1782 TD 0.0232 Tc -0.0466 Tw (RK is being performed less frequently \(25\), and PRK)Tj T* -0.0199 Tw (has been substantially replaced by LASIK as the pro-)Tj 0 -1.1891 TD 0.026 Tw (cedure of choice \(26\). Clinical studies conducted in)Tj 0 -1.1782 TD 0.0235 Tc -0.0033 Tw (the United States and other countries have provided)Tj T* 0.0233 Tc -0.1145 Tw (valuable short-term information about laser refractive)Tj 0 -1.1891 TD 0.023 Tc 0.1836 Tw (surgery. However, long-term stability \(27,28\) and)Tj 0 -1.1782 TD 0.0236 Tc 0.2493 Tw (possible variations in vision performance, due to)Tj T* 0.0231 Tc 0.0143 Tw (normal age-related changes in the human visual sys-)Tj 0 -1.1891 TD -0.0045 Tw (tem, will not be known for some time \(29,30,31\). If)Tj 0 -1.1782 TD 0.0419 Tw [(concerns regarding laser refractive procedures prove)]TJ T* 0.0234 Tc 0.0541 Tw (prophetic, it can have a severe impact on the visual)Tj 0 -1.1891 TD 0.0227 Tc -0.125 Tw (performance of pilots and aviation safety in the future.)Tj 1.0909 -1.1782 TD 0.0233 Tc 0.0786 Tw (Although the vast majority of patients who have)Tj -1.0909 -1.1782 TD -0.0818 Tw (had laser refractive procedures experience satisfactory)Tj 0 -1.1891 TD -0.0483 Tw (results, there is a small percentage of individuals who)Tj 0 -1.1782 TD 0.0231 Tc -0.0084 Tw (have less than optimal surgical outcomes \(32,33\). In)Tj T* 0.0234 Tc -0.08 Tw (some cases, enhancement procedures cannot improve)Tj 0 -1.1891 TD 0.0608 Tw (the quality of vision that remains for these patients)Tj 0 -1.1782 TD 0.0232 Tc 0.037 Tw (\(34,35\). The demands placed on a pilots vision are)Tj T* -0.125 Tw (often extraordinary. First-class airmen are tested every)Tj 0 -1.1891 TD 0.0234 Tc -0.0949 Tw (six months, and the vision standards for these aviators)Tj 0 -1.1782 TD 0.0285 Tw [(are stringent. A poor surgical outcome or complica-)]TJ T* 0.0236 Tc 0.202 Tw (tion perceived as a minor inconvenience to some)Tj 0 -1.1891 TD 0.0163 Tw (individuals can be a career-compromising condition)Tj 0 -1.1782 TD 0.0233 Tc 0.0152 Tw (for the professional pilot. Before choosing refractive)Tj T* 0.0231 Tc 0.0424 Tw (surgery, a pilot should be aware of the possible side)Tj 0 -1.1891 TD 0.0018 Tw (effects associated with these procedures \(36\).)Tj 1.0909 -1.1782 TD 0.0234 Tc -0.0296 Tw (Subjective complaints following refractive surgery)Tj -1.0909 -1.1782 TD 0.0764 Tw (include reduced contrast sensitivity, increased glare)Tj 0 -1.1891 TD -0.0805 Tw (sensitivity, and the loss of best-corrected visual acuity)Tj 0 -1.1782 TD 0.0232 Tc -0.092 Tw (\(10\). Some patients, who report seeing well in normal)Tj T* 0.0236 Tc -0.113 Tw (room lighting conditions, have found night driving to)Tj 0 -1.1891 TD 0.0234 Tc 0.1805 Tw (be difficult or impossible due to aberrations \(i.e.,)Tj 0 -1.1782 TD 0.0231 Tc -0.0909 Tw (halos, starbursts, and ghost images\) from street lights,)Tj T* 0.0901 Tw (traffic lights, and oncoming headlights \(12\). These)Tj 0 -1.1891 TD 0.0233 Tc 0.0909 Tw (complaints may be associated with residual corneal)Tj 0 -1.1782 TD 0.0231 Tc -0.0409 Tw (haze and/or de-centered ablation zones \(37,38\). Fur-)Tj T* 0.0233 Tc 0.1009 Tw (thermore, under-correction of the refractive condi-)Tj 0 -1.1891 TD 0.0664 Tc 0.25 Tw (tion can result in poor distant vision, while)Tj 0 -1.1782 TD 0.0234 Tc -0.0409 Tw (over-correction can produce premature presbyopia)Tj T* -0.1167 Tw (\(i.e., an inability to see objects at near distances clearly)Tj 0 -1.1891 TD -0.0438 Tw (due to a loss of accommodation that normally occurs)Tj 0 -1.1782 TD 0.1061 Tw (with aging\) or exacerbate a pre-existing presbyopic)Tj T* 0.0239 Tc 0.0136 Tw (condition \(39\).)Tj ET endstream endobj 110 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R >> /ExtGState << /GS4 34 0 R >> >> endobj 112 0 obj << /Length 8993 >> stream BT /F1 1 Tf 10 0 0 10 311.16 36 Tm 0 0 0 1 k /GS4 gs 0.02 Tc 0 Tw (11)Tj 11 0 0 11 84 729.36 Tm 0.0233 Tc 0.0721 Tw (Clinical studies have suggested that a number of)Tj -1.0909 -1.1782 TD 0.1727 Tw (factors can influence the results of laser refractive)Tj 0 -1.1891 TD 0.0628 Tw (surgical procedures, including the magnitude of re-)Tj 0 -1.1782 TD 0.0765 Tw (fractive correction, age, and gender. Several studies)Tj T* -0.0968 Tw [(have concluded that the predictability of the resulting)]TJ 0 -1.1891 TD 0.0182 Tw (refractive correction decreases with increased refrac-)Tj 0 -1.1782 TD 0.023 Tc 0.1061 Tw (tive error \(40,41,42\). Other research suggests that,)Tj T* 0.0147 Tc -0.1247 Tw (since they often experience less regression than younger)Tj 0 -1.1891 TD 0.0166 Tc (patients who have similar procedures to correct equiva-)Tj 0 -1.1782 TD 0.0232 Tc 0.2292 Tw (lent refractive error, older patients have a higher)Tj T* 0.0637 Tw (frequency of over correction after refractive surgery)Tj 0 -1.1891 TD 0.1424 Tw (\(29,30\). Some clinical studies suggest that women)Tj 0 -1.1782 TD 0.0234 Tc 0.2191 Tw (taking contraceptives \(41\), who become pregnant)Tj T* 0.0231 Tc 0.0761 Tw (during the healing process \(43\), or who are treated)Tj 0 -1.1891 TD 0.056 Tw (with hormones for menopause have less predictable)Tj 0 -1.1782 TD -0.0539 Tw (refractive results \(44,45\). Also, those exposed to high)Tj T* 0.0235 Tc -0.1 Tw (levels of ultraviolet radiation \(solar radiation, tanning)Tj 0 -1.1891 TD 0.0232 Tc 0.1019 Tw (beds\) were more prone to refractive regression and)Tj 0 -1.1782 TD 0.023 Tc 0.0672 Tw (late-onset-corneal haze \(41,46\). Regression was sig-)Tj T* 0.0233 Tc 0.053 Tw (nificantly higher in those with ocular-surface disor-)Tj 0 -1.1891 TD 0.0274 Tc 0.25 Tw (ders, such as dry eyes \(41\). One study found a)Tj 0 -1.1782 TD 0.0237 Tc 0.2188 Tw (significant myopic shift in the corneas of LASIK)Tj T* 0.0234 Tc 0.1925 Tw [(patients exposed to hypoxia when compared with)]TJ 0 -1.1891 TD 0.0231 Tc 0.0006 Tw (myopic control subjects \(47\). These results could be)Tj 0 -1.1782 TD 0.0311 Tw (particularly worrisome for pilots who are repeatedly)Tj T* 0.1591 Tw (exposed to high levels of solar radiation, the low-)Tj 0 -1.1891 TD 0.0237 Tc 0.2477 Tw (humidity environment of a cockpit, and altitude)Tj 0 -1.1782 TD 0.0242 Tc 0 Tw (hypoxia.)Tj 1.0909 -1.1782 TD 0.0233 Tc 0.0652 Tw (In conclusion, airmen with refractive surgery are)Tj -1.0909 -1.1891 TD 0.2312 Tw (present in all classes of medical certification. Al-)Tj 0 -1.1782 TD -0.0916 Tw (though mean accident rates for airmen with refractive)Tj T* 0.023 Tc -0.0824 Tw (surgery were higher in all classes of medical certificate)Tj 0 -1.1891 TD 0.0232 Tc -0.0902 Tw (holders, statistical analysis found that these rates were)Tj 0 -1.1782 TD 0.0909 Tw (not significantly higher \(p > 0.05\) when compared)Tj T* 0.2432 Tw (with those for airmen without refractive surgery.)Tj 0 -1.1891 TD 0.0236 Tc -0.1156 Tw (Considering the anticipated increase in the number of)Tj 0 -1.1782 TD 0.0231 Tc 0.1012 Tw [(laser refractive surgery procedures that will be per-)]TJ T* 0.0235 Tc -0.0578 Tw (formed in the future, the possibility of complications)Tj 0 -1.1891 TD -0.1015 Tw (or side effects that may be compounded in the cockpit)Tj 0 -1.1782 TD 0.0237 Tc -0.0902 Tw (environment, and the lack of information concerning)Tj T* 0.0232 Tc 0.0969 Tw (the possible long-term effects of newer procedures,)Tj 0 -1.1891 TD 0.031 Tw (further study is required. Additional research incor-)Tj 0 -1.1782 TD 0.0236 Tc 0.2136 Tw (porating age stratification may help to determine)Tj T* 0.0231 Tc -0.0624 Tw (whether the normal age-related changes in vision will)Tj 0 -1.1891 TD 0.0233 Tc -0.1189 Tw (influence the effectiveness of refractive surgical proce-)Tj 0 -1.1782 TD 0.0235 Tc 0.0073 Tw (dures as the pilot ages. )Tj 9.5127 0 TD 0.003 Tc 0.008 Tw (Finally, since this study exam-)Tj -9.5127 -1.1782 TD 0.0036 Tc -0.0819 Tw (ined a refractive surgery population consisting primarily)Tj 0 -1.1891 TD 0.0037 Tc -0.0466 Tw (of pilots with RK, continued monitoring is necessary to)Tj 0 -1.1782 TD 0.0032 Tc 0.0533 Tw (determine if the newer laser refractive procedures per-)Tj T* 0.0037 Tc 0.0018 Tw (form satisfactorily in the aviation environment.)Tj /F8 1 Tf 12 0 0 12 403.2 729.36 Tm 0.0186 Tc 0 Tw (REFERENCES)Tj /F1 1 Tf 11 0 0 11 324 697.3201 Tm 0.0028 Tc -0.1 Tw [(1.)-1426.3(American Optometric Association, Committee on)]TJ 2.1818 -1.1782 TD 0.0034 Tc 0.2227 Tw (Information and Data. Caring for the eyes of)Tj T* 0.0682 Tw (America: A profile of the optometric profession.)Tj 0 -1.1891 TD -0.0005 Tc -0.1 Tw (1996. American Optometric Association: St Louis,)Tj 0 -1.1782 TD 0.0031 Tc 0.0091 Tw (MO. IDI/96.)Tj -2.1818 -1.7236 TD 0.0033 Tc 0.047 Tw [(2.)-1425.8(McDonald M. Beyond approval: whats next for)]TJ 2.1818 -1.1891 TD 0.0039 Tc 0 Tw (PRK. )Tj /F10 1 Tf 2.3891 0 TD 0.0026 Tc 0.0045 Tw (Eyecare Technology)Tj /F1 1 Tf 7.1564 0 TD 0.0036 Tc 0.0061 Tw (. Jan 1996; )Tj /F8 1 Tf 4.5818 0 TD 0 Tc 0 Tw (6)Tj /F1 1 Tf 0.5127 0 TD 0.0025 Tc (\(1\):44-6.)Tj -16.8218 -1.7236 TD 0.0032 Tc 0.2409 Tw [(3.)-1425.9(Nakagawara VB, Wood KJ, and Montgomery)]TJ 2.1818 -1.1782 TD 0.0033 Tc -0.0857 Tw (RW. Refractive surgery in the civil airman popula-)Tj 0 -1.1891 TD 0.0035 Tc -0.0335 Tw (tion by class of medical certificate and by aviation)Tj 0 -1.1782 TD 0.0079 Tc 0.25 Tw (occupation. 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Caring for the eyes of)Tj 0 -1.1782 TD 0.0032 Tc 0.1391 Tw (America 2000. 2000 American Optometric As-)Tj T* 0.0038 Tc 0.0106 Tw (sociation: St Louis, MO.)Tj -2.1818 -1.7345 TD 0.0027 Tc 0 Tw (6.)Tj /F10 1 Tf 2.1818 0 TD 0.0029 Tc 0.1584 Tw (Investors Should Set Their Sights on Vision Care)Tj 0 -1.1782 TD 0.0035 Tc 0 Tw (Stocks; )Tj /F1 1 Tf 2.6836 0 TD -0.0545 Tw (http://optistock.com/iis.htm#vision 2002.)Tj -4.8655 -1.7236 TD 0.0032 Tc -0.0345 Tw [(7.)-1425.9(Diamond S. Excimer laser photorefractive kerate-)]TJ 2.1818 -1.1891 TD 0.0033 Tc 0.1272 Tw (ctomy \(PRK\) for myopiapresent status: aero-)Tj 0 -1.1782 TD 0.0037 Tc -0.0864 Tw (space considerations. )Tj /F10 1 Tf 8.2145 0 TD 0.0031 Tc (Aviat Space Environ Med.)Tj /F1 1 Tf 9.6 0 TD 0.0044 Tc -0.0909 Tw [( Jul)]TJ -17.8145 -1.1782 TD 0 Tw (1995; )Tj /F8 1 Tf 2.5309 0 TD -0.0055 Tc (66)Tj /F1 1 Tf 1.0145 0 TD 0.0024 Tc (\(7\):690-3.)Tj -5.7273 -1.7345 TD 0.0032 Tc 0.0974 Tw [(8.)-1425.9(Maloney RK, and Faktorovich EG. There is no)]TJ 2.1818 -1.1782 TD 0.0034 Tc 0.0757 Tw (benefit to deferring laser refractive surgery. )Tj /F10 1 Tf 17.3345 0 TD 0.0021 Tc 0 Tw (Arch)Tj -17.3345 -1.1782 TD 0.0034 Tc (Ophthalmol.)Tj /F1 1 Tf 4.7673 0 TD 0.0031 Tc 0.0122 Tw [( May 1998; )]TJ /F8 1 Tf 4.8218 0 TD -0.0014 Tc 0 Tw (116)Tj /F1 1 Tf 1.5382 0 TD 0.0024 Tc (\(5\):669-72.)Tj -13.3091 -1.7345 TD 0.0032 Tc 0.1576 Tw [(9.)-1425.9(Tong PPC, et al. Excimer laser photorefractive)]TJ 2.1818 -1.1782 TD 0.0033 Tc 0.0855 Tw (keratectomy for myopia: six-month follow-up. )Tj /F10 1 Tf 18.7527 0 TD 0 Tc 0 Tw (J)Tj -18.7527 -1.1782 TD 0.0024 Tc (Cataract Refract Surg)Tj /F1 1 Tf 8.0618 0 TD 0.003 Tc (. Mar 1995; )Tj /F8 1 Tf 4.9309 0 TD -0.0055 Tc (21)Tj /F1 1 Tf 1.0255 0 TD 0.0027 Tc (:150-5.)Tj -16.2 -1.7345 TD 0.0134 Tc 0.25 Tw [(1)11.1(0)11.1(.)-913.9(Seiler T, and McDonnnell PJ. Excimer laser)]TJ 2.1818 -1.1782 TD 0.0064 Tc (photorefractive keratectomy. )Tj /F10 1 Tf 12.0218 0 TD 0.0068 Tc (Surv Ophthalmol.)Tj /F1 1 Tf -12.0218 -1.1782 TD 0.0031 Tc -0.0023 Tw (Sep-Oct 1995; )Tj /F8 1 Tf 6 0 TD -0.0055 Tc 0 Tw (40)Tj /F1 1 Tf 1.0255 0 TD 0.0024 Tc (\(2\):89-118.)Tj 6.4 0 0 6.4 324 105.36 Tm 0 Tc (1.)Tj 9 0 0 9 332.04 101.76 Tm 0.0084 Tc 0.25 Tw [(This report and all Office of Aerospace Medicine technical)]TJ -0.8933 -1.2267 TD 0.0074 Tc -0.0733 Tw (reports published between 1961 and the present are also available in)Tj 0 -1.1067 TD 0.0118 Tw (full-text at the Civil Aerospace Medical Institutes Web site:)Tj T* 0.0081 Tc 0 Tw (http://www.cami.jccbi.gov/aam-400A/Abstracts/Tech_Rep.htm)Tj ET 0 0 0 1 K 0 J 0 j 0.24 w 10 M []0 d /GS5 gs 1 i 324 118.92 m 468 118.92 l S endstream endobj 113 0 obj << /ProcSet [/PDF /Text ] /Font << /F1 4 0 R /F8 33 0 R /F10 114 0 R >> /ExtGState << /GS4 34 0 R /GS5 35 0 R >> >> endobj 116 0 obj << /Length 9976 >> stream BT /F1 1 Tf 10 0 0 10 292.92 36.96 Tm 0 0 0 1 k /GS4 gs 0.02 Tc 0 Tw (12)Tj 11 0 0 11 54 729.36 Tm 0.0031 Tc -0.0621 Tw [(11.)-924.2(Farah SG, Azar DT, Gurdal C, and Wong J. Laser)]TJ 2.1818 -1.1782 TD 0.0034 Tc -0.0747 Tw (in situ keratomileusis: Literature review of a devel-)Tj 0 -1.1891 TD 0.0038 Tc -0.075 Tw (oping technique. )Tj /F10 1 Tf 6.6873 0 TD 0.0028 Tc -0.0773 Tw (J Cataract Refract Surg)Tj /F1 1 Tf 8.4218 0 TD 0.0032 Tc (. Jul 1998;)Tj /F8 1 Tf -15.1091 -1.1782 TD -0.0055 Tc 0 Tw (24)Tj /F1 1 Tf 1.0255 0 TD 0.0032 Tc (\(7\):989-1006.)Tj -3.2073 -1.7236 TD 0.003 Tc 0.0748 Tw [(12.)-924.3(Schlote T, Kriegerowski M, Bende T, Derse M,)]TJ 2.1818 -1.1891 TD 0.0035 Tc 0.0341 Tw (Thiel HJ, and Jean B. Mesopic vision in myopia)Tj 0 -1.1782 TD -0.0025 Tc -0.1 Tw (corrected by photorefractive keratectomy, soft con-)Tj T* 0.0034 Tc -0.025 Tw (tact lenses, and spectacles. )Tj /F10 1 Tf 10.2655 0 TD 0.0027 Tc -0.0258 Tw (J Cataract Refract Surg)Tj /F1 1 Tf 8.5745 0 TD 0 Tc 0 Tw (.)Tj -18.84 -1.1891 TD 0.0041 Tc 0.0046 Tw (Jun 1997; )Tj /F8 1 Tf 4.1782 0 TD -0.0055 Tc 0 Tw (23)Tj /F1 1 Tf 1.0255 0 TD 0.0024 Tc (\(5\):718-25.)Tj -7.3855 -1.7236 TD 0.0032 Tc -0.0389 Tw [(13.)-924.1(Creel DJ, Crandall AS, and Swartz M. Hyperopic)]TJ 2.1818 -1.1782 TD 0.0033 Tc 0.0221 Tw (shift induced by high altitude after radial kerato-)Tj 0 -1.1891 TD 0.0028 Tc 0 Tw (tomy. )Tj /F10 1 Tf 2.6836 0 TD 0.0025 Tc 0.1409 Tw (J Refract Surg)Tj /F1 1 Tf 5.4327 0 TD 0.0035 Tc 0.141 Tw (. Jul-Aug 1997; )Tj /F8 1 Tf 6.72 0 TD -0.0055 Tc 0 Tw (13)Tj /F1 1 Tf 1.0255 0 TD 0.0027 Tc (\(4\):398-)Tj -15.8618 -1.1782 TD 0.0021 Tc (400.)Tj -2.1818 -1.7236 TD 0.0032 Tc 0.0468 Tw [(14.)-924.1(White LJ, and Mader TH. Refractive changes at)]TJ 2.1818 -1.1891 TD 0.0035 Tc 0.1382 Tw (high altitude after LASIK. [Letter] )Tj /F10 1 Tf 14.3236 0 TD 0.0034 Tc 0 Tw (Ophthalmol.)Tj /F1 1 Tf -14.3236 -1.1782 TD 0.0091 Tw (Dec 2000; )Tj /F8 1 Tf 4.3745 0 TD -0.0014 Tc 0 Tw (107)Tj /F1 1 Tf 1.5382 0 TD 0.003 Tc (\(12\):2118.)Tj -8.0945 -1.7236 TD 0.0032 Tc 0.2305 Tw [(15)-1175(Nelson, ML, Brady S, Mader TH, White LJ,)]TJ 2.1818 -1.1891 TD -0.0114 Tw (Parmley VC, and Winkle RK. Refractive changes)Tj 0 -1.1782 TD 0.0034 Tc -0.0676 Tw (caused by hypoxia after laser in situ keratomileusis)Tj T* 0.0027 Tc 0 Tw (surgery. )Tj /F10 1 Tf 3.3055 0 TD 0.0034 Tc (Ophthalmol.)Tj /F1 1 Tf 4.7782 0 TD 0.0036 Tc 0.006 Tw [( Mar 2001; )]TJ /F8 1 Tf 4.6909 0 TD -0.0014 Tc 0 Tw (108)Tj /F1 1 Tf 1.5382 0 TD 0.0024 Tc (\(3\):542-4.)Tj -16.4945 -1.7345 TD 0.003 Tc 0.0378 Tw [(16.)-924.3(Gimbel HV, Basti S, Kaye GB, and Ferensowicz)]TJ 2.1818 -1.1782 TD 0.0034 Tc -0.0909 Tw (M. Experience during the learning curve of laser in)Tj T* 0.0035 Tc 0.1341 Tw (situ keratomileusis. )Tj /F10 1 Tf 7.9964 0 TD 0.0028 Tc 0.1333 Tw (J Cataract Refract Surg)Tj /F1 1 Tf 9.0545 0 TD 0.0054 Tc 0.1364 Tw (. Jun)Tj -17.0509 -1.1891 TD 0.0044 Tc 0 Tw (1996; )Tj /F8 1 Tf 2.5309 0 TD -0.0055 Tc (22)Tj /F1 1 Tf 1.0255 0 TD 0.0024 Tc (\(5\):542-50.)Tj -5.7382 -1.7236 TD 0.0031 Tc 0.0916 Tw [(17.)-924.2(Davidorf JM, Zaldivar R, and Oscherow S. Re-)]TJ 2.1818 -1.1782 TD 0.0035 Tc 0.1792 Tw (sults and complications of laser in situ kerato-)Tj 0 -1.1891 TD 0.0032 Tc 0.0659 Tw (mileusis by experienced surgeons. )Tj /F10 1 Tf 13.5491 0 TD 0.0028 Tc 0.0682 Tw (J Refract Surg)Tj /F1 1 Tf 5.2909 0 TD 0 Tc 0 Tw (.)Tj -18.84 -1.1782 TD 0.0033 Tc -0.0023 Tw (Mar-Apr 1998; )Tj /F8 1 Tf 6.2182 0 TD -0.0055 Tc 0 Tw (14)Tj /F1 1 Tf 1.0255 0 TD 0.0024 Tc (\(2\):114-22.)Tj -9.4255 -1.7236 TD 0.0032 Tc -0.0516 Tw [(18.)-924.1(Dille JR, and Booze CF Jr. Accident experience of)]TJ 2.1818 -1.1891 TD 0.0034 Tc 0.0492 Tw (civilian pilots with static physical defects. Wash-)Tj 0 -1.1782 TD 0.0037 Tc -0.0137 Tw (ington, DC: Department of Transportation/Fed-)Tj T* 0.0036 Tc 0.0309 Tw (eral Aviation Administration. 1976; FAA Report)Tj 0 -1.1891 TD 0.003 Tc 0.0246 Tw (No. AM-76-7. Available from: National Techni-)Tj 0 -1.1782 TD 0.0034 Tc 0.0782 Tw (cal Information Service, Springfield, VA 22161.)Tj T* 0.003 Tc -0.0046 Tw (Order # ADA209431/4GI)Tj 6.4 0 0 6.4 191.88 249 Tm 0 Tc 0 Tw (1.)Tj 11 0 0 11 54 226.32 Tm 0.003 Tc 0.183 Tw [(19.)-924.3(Dille JR, and Booze CF Jr. The prevalence of)]TJ 2.1818 -1.1782 TD 0.0034 Tc 0.1273 Tw (visual deficiencies among 1979 general aviation)Tj T* 0.0037 Tc 0.0806 Tw (accident airmen. Washington, DC: Department)Tj 0 -1.1891 TD 0.0036 Tc 0.1545 Tw (of Transportation/Federal Aviation Administra-)Tj 0 -1.1782 TD 0.0031 Tc -0.0894 Tw (tion. 1981; FAA Report No. AM-81-14. Available)Tj T* 0.0034 Tc 0.2227 Tw (from: National Technical Information Service,)Tj 0 -1.1891 TD -0.0009 Tw (Springfield, VA 22161. Order # ADA106489/8)Tj 6.4 0 0 6.4 283.2 152.04 Tm 0 Tc 0 Tw (1.)Tj 11 0 0 11 306 729.36 Tm 0.003 Tc 0.0652 Tw [(20.)-924.3(Dille JR, and Booze CF Jr. The 1980 and 1981)]TJ 2.1818 -1.1782 TD 0.0033 Tc 0.0144 Tw (accident experiences of civil airmen with selected)Tj 0 -1.1891 TD 0.0034 Tc 0.0546 Tw (visual pathology. Washington, DC: Department)Tj 0 -1.1782 TD 0.0036 Tc 0.1545 Tw (of Transportation/Federal Aviation Administra-)Tj T* 0.0031 Tc -0.0894 Tw (tion. 1983; FAA Report No. AM-83-18. Available)Tj 0 -1.1891 TD 0.0034 Tc 0.2227 Tw (from: National Technical Information Service,)Tj 0 -1.1782 TD 0.0032 Tc -0.0009 Tw (Springfield, VA 22161. Order # ADA134898)Tj 6.4 0 0 6.4 525.96 654.96 Tm 0 Tc 0 Tw (1.)Tj 11 0 0 11 306 632.4 Tm 0.0239 Tc 0.125 Tw [(2)21.6(1)21.6(.)-903.4(United States Department of Transportation.)]TJ 2.1818 -1.1891 TD 0.0236 Tc 0.0363 Tw (Aeromedical certification statistical handbook.)Tj 0 -1.1782 TD 0.0232 Tc -0.006 Tw (1994-1996. Washington, DC:Federal Aviation)Tj T* 0.0278 Tc 0.25 Tw (Administration. Civil Aeromedical Institute,)Tj 0 -1.1891 TD 0.0218 Tc -0.1 Tw (Aeromedical Certification Division. Report No.)Tj 0 -1.1782 TD 0.0234 Tc 0.0046 Tw (AC 8500-1.)Tj -2.1818 -1.7236 TD 0.003 Tc 0.2371 Tw [(22.)-924.3(Hawks TF. Will LASIK overtake PRK as the)]TJ 2.1818 -1.1891 TD 0.0031 Tc 0.0545 Tw (preferred refractive surgery choice? )Tj /F10 1 Tf 13.92 0 TD 0.0591 Tw (Primary Care)Tj -13.92 -1.1782 TD 0.0028 Tc 0.0046 Tw (Optometry News)Tj /F1 1 Tf 6.24 0 TD 0.0035 Tc 0.006 Tw (. Nov 1996; )Tj /F8 1 Tf 4.9964 0 TD 0 Tc 0 Tw (1)Tj /F1 1 Tf 0.5236 0 TD 0.0034 Tc (\(10\):23.)Tj -13.9418 -1.7236 TD -0.0083 Tc -0.1 Tw [(2)-10.6(3)-10.6(.)-935.6(Dulaney DD, Barnet RW, Perkins SA, and Kezirian)]TJ 2.1818 -1.1891 TD 0.0035 Tc 0.0214 Tw (GM. 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Oct 15, 1994. )Tj /F8 1 Tf 6.3164 0 TD -0.0055 Tc 0 Tw (33)Tj /F1 1 Tf 1.0255 0 TD 0.0018 Tc (\(8\):7.)Tj -11.5418 -1.7236 TD 0.0032 Tc 0.0248 Tw [(26.)-924.1(Dutton J, and Slamovits T, Eds. Surgical correc-)]TJ 2.1818 -1.1782 TD 0.0197 Tw (tion of moderate myopia: Which method should)Tj 0 -1.1891 TD 0.0088 Tc 0.25 Tw (you choose. )Tj /F10 1 Tf 5.4 0 TD (Surv Ophthalmol)Tj /F1 1 Tf 6.8509 0 TD 0.009 Tc (. Sep-Oct 1998;)Tj /F8 1 Tf -12.2509 -1.1782 TD -0.0055 Tc 0 Tw (43)Tj /F1 1 Tf 1.0255 0 TD 0.0035 Tc (\(2\):147-81.)Tj -3.2073 -1.7236 TD 0.0031 Tc -0.0999 Tw [(27.)-924.2(Augustine JM. Postoperative advantages of LASIK)]TJ 2.1818 -1.1891 TD 0.0034 Tc 0.0939 Tw (outweigh intraoperative risks. )Tj /F10 1 Tf 12.0327 0 TD 0.0028 Tc 0.0954 Tw (Primary Care Op-)Tj -12.0327 -1.1782 TD 0.0026 Tc 0 Tw (tometry News.)Tj /F1 1 Tf 5.3018 0 TD 0.0033 Tc 0.0042 Tw ( Mar 1996; )Tj /F8 1 Tf 4.6909 0 TD 0 Tc 0 Tw (1)Tj /F1 1 Tf 0.5127 0 TD 0.0018 Tc (\(2\):32.)Tj -12.6873 -1.7236 TD 0.0031 Tc 0.2266 Tw [(28.)-924.2(Maguire LJ. Should laser refractive surgery be)]TJ 2.1818 -1.1891 TD 0.022 Tw (delayed? The benefits in deferring laser refractive)Tj 0 -1.1782 TD 0.0583 Tc 0.25 Tw (surgery outweigh the disadvantages. )Tj /F10 1 Tf 17.16 0 TD 0.0603 Tc 0 Tw (Arch)Tj -17.16 -1.1782 TD 0.0037 Tc (Ophthalmol)Tj /F1 1 Tf 4.5164 0 TD 0.0029 Tc 0.0122 Tw (. 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