{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T01:29:38Z","timestamp":1783128578678,"version":"3.54.6"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"5-6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Diplopia and strabismus are known complications after corneal refractive surgery (CRS). Within the U.S. Armed Forces, refractive surgery is used to improve the operational readiness of the service member, and these complications could cause significant degradation to their capability. This study was performed in order to identify the incidence of strabismus and diplopia following CRS within the U.S. Military Health System.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of all patients who underwent photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK) in the Department of Defense from January 2006 through September 2013 was designed and approved by the Naval Medical Center Portsmouth Institutional Review Board. The military health system data mart was queried for all patients who underwent one of these procedures and subsequently had an International Classification of Disease-9 code for any strabismus or diplopia through 2014 allowing at least 1 year of follow-up. We then calculated the incidence of both diplopia and strabismus for these procedures as the primary measure and the overall prevalence as a secondary measure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 108,157 patients underwent PRK or LASIK during our study period with 41 of these patients subsequently having a diagnosis of diplopia or strabismus. After chart review, 16 of these patients were excluded resulting in 25 patients for inclusion in either the strabismus (23 patients, 0.02%) or diplopia (3 patients, 0.003%) cohorts with one patient having both. Of the 23 patients with postoperative strabismus, 4 were new cases giving an incidence of 0.004% and 2 new cases of diplopia for an incidence of 0.002%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Diplopia and strabismus are rare complications after CRS in the U.S. military population. These procedures continue to increase the operational readiness of our service members with minimal risk of these potentially debilitating complications. Overall, this study provides support for the continued use of PRK and LASIK despite study limitations related to the use of large databases for retrospective review. Future prospective studies using delineated preoperative and postoperative examinations with sensorimotor testing included may be able to resolve the limitations of this study.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usz395","type":"journal-article","created":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T15:19:47Z","timestamp":1575645587000},"page":"e755-e758","source":"Crossref","is-referenced-by-count":7,"title":["Diplopia and Strabismus After Corneal Refractive Surgery"],"prefix":"10.1093","volume":"185","author":[{"given":"Aditya","family":"Mehta","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan","family":"Reed","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle E","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Naval Medical Center Portsmouth. 620 John Paul Jones Cr., Portsmouth, VA 23708, USA"},{"name":"Department of Surgery, Uniformed Services University, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,12,6]]},"reference":[{"key":"2020060910242982800_ref1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1111\/j.1442-9071.2005.00953.x","article-title":"Refractive surgery and strabismus","volume":"33","author":"Kowal","year":"2005","journal-title":"Clin Exp Ophthalmol"},{"key":"2020060910242982800_ref2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0039-6257(01)00254-5","article-title":"LASIK complications: etiology, management, and prevention","volume":"46","author":"Melki","year":"2001","journal-title":"Surv Ophthalmol"},{"key":"2020060910242982800_ref3","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/00004397-200007000-00009","article-title":"LASIK complications","volume":"40","author":"Davis","year":"2000","journal-title":"Int Ophthalmol Clin"},{"key":"2020060910242982800_ref4","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1001\/archopht.121.3.315","article-title":"Diplopia after refractive surgery","volume":"121","author":"Kushner","year":"2003","journal-title":"Arch Ophthalmol"},{"key":"2020060910242982800_ref5","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/ICU.0b013e32833bd850","article-title":"Diplopia in adult patients following cataract extraction and refractive surgery","volume":"21","author":"Gunton","year":"2010","journal-title":"Curr Opin Ophthalmol"},{"key":"2020060910242982800_ref6","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jaapos.2012.10.008","article-title":"Diplopia after laser in situ keratomileusis (LASIK) in a patient with a history of strabismus","volume":"17","author":"Heinmiller","year":"2013","journal-title":"J AAPOS"},{"issue":"11","key":"2020060910242982800_ref7","first-page":"363","article-title":"Strabismsus and diplopia after refractive surgery","volume":"87","author":"Gomez de Liano-Sanchez","year":"2012","journal-title":"Arch Soc Esp Eftalmol"},{"key":"2020060910242982800_ref8","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/S0886-3350(99)00208-4","article-title":"Decompensated strabismus after laser in situ keratomileusis","volume":"25","author":"Schuler","year":"1999","journal-title":"J Cataract Refract Surg"},{"key":"2020060910242982800_ref9","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/S0886-3350(02)01695-4","article-title":"Exodeviation following monocular myopic regression after laser in situ keratomileusis","volume":"29","author":"Yildirim","year":"2003","journal-title":"J Cataract Refract Surg"},{"key":"2020060910242982800_ref10","doi-asserted-by":"crossref","first-page":"363","DOI":"10.3928\/1542-8877-20030901-04","article-title":"Decompensation of exodeviation after corneal refractive surgery for moderate to high myopia","volume":"34","author":"Snir","year":"2003","journal-title":"Ophthalmic Surg Lasers Imaging"},{"issue":"11","key":"2020060910242982800_ref11","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1038\/eye.2014.209","article-title":"a: Impact of laser refractive surgery on ocular alignment in myopic patients","volume":"28","author":"Chung","year":"2014","journal-title":"Eye (Lond)"},{"key":"2020060910242982800_ref12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1046\/j.1442-9071.2001.00418.x","article-title":"Diplopia as a complication of laser in situ keratomileusis surgery","volume":"29","author":"Yap","year":"2001","journal-title":"Clin Exp Ophthalmol"},{"key":"2020060910242982800_ref13","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/S0886-3350(01)01279-2","article-title":"Cyclotorsion: a possible cause of residual astigmatism in refractive surgery","volume":"28","author":"Tjon-Fo-Sang","year":"2002","journal-title":"J Cataract Refract Surg"},{"key":"2020060910242982800_ref14","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1016\/S0886-3350(99)00208-4","article-title":"Decompensated strabismus after laser in situ keratomileusis","volume":"25","author":"Schuler","year":"1999","journal-title":"J Cataract Refract Surg"},{"issue":"2","key":"2020060910242982800_ref15","doi-asserted-by":"crossref","first-page":"e145","DOI":"10.1111\/aos.13891","article-title":"Binocular vision alterations after refractive and cataract surgery: a review","volume":"97","author":"Garcia-Montero","year":"2019","journal-title":"Acta Ophthalmol"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/185\/5-6\/e755\/33370136\/usz395.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/article-pdf\/185\/5-6\/e755\/33370136\/usz395.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T21:51:16Z","timestamp":1665179476000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/185\/5-6\/e755\/5663469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,6]]},"references-count":15,"journal-issue":{"issue":"5-6","published-online":{"date-parts":[[2019,12,6]]},"published-print":{"date-parts":[[2020,6,8]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usz395","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5]]},"published":{"date-parts":[[2019,12,6]]}}}