1 Laser Exposure to AircrewCAPT Matt Rings Aerospace Ophthalmology Naval Aerospace Medical Institute (Sep 2016 Update)

2 Laser Threats Low Energy Handheld Laser Pointers (Red/Green/Blue)CAS lasers (vis/IR) Airborne lasers – targeting and countermeasures (vis/IR) Anti-personnel lasers (Green)

3 Laser Weapon Systems Navy LaWS – 30kW IR, radar guidedUSA: Kilowatt anti-aircraft/artillery laser, approximately $1 per “round” Russian 1K17 Szhatie Anti-missile/aircraft laser Chinese Anti-aircraft laser

4 Laser Categories Class I – no cautions, no injury (< 0.39 mW)Example: grocery store scanner Class II – laser pointers, caution label (< 1 mW) Blink reflex usually sufficient Eye injury unlikely unless prolonged exposure Class IIIa – medical, research (1 – 5 mW) Eye injury possible <0.25sec Class IIIb – weapons, DANGER (5 – 500mW) Eye injury likely, blink reflex too slow Class IV – weapons, DANGER (500mW+) Reflections dangerous Skin Injury & burns to exposed areas Fire hazard

5 YouTube Video

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7 Laser Physical EffectsFlash-blindness Irritation Photophobia Headache & eye pain Sub-clinical tissue damage Visible ocular burns Retinal hemorrhage

8 Laser Operational EffectsEye more sensitive to green wavelength Surprise / Startle Effect Distraction Inability to discern instruments and landing lights Mission compromise or failure Loss of aviator temporarily or permanently to flight

9 Laser Dazzle YouTube Video

10 Tahrir Square - Egypt

11 Approach, Nov/Dec 2012

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13 Commercial / Civil Aircraft2004: 46 incidences 2014: 3894 2015: 7249 2% pain 22% below 2000’ 92% green lasers 2% Blue/Purple 1% red lasers 70% Night-time 11% : distraction, glare, afterimage, ops interference The Illumination of Aircraft at Altitude by Laser Beams: A 5-Year Study Period ( FAA

14 2015 DoD Aviation IncidencesUSAF 58 US Army 4 US Navy 8 USMC 10

15 Laser Eye Protection (LEP)LEP blocking methods: Reflective, Absorptive, Optical Bandpass Filtering New Tech: multiple wavelength protection

16 Laser Eye Protection (LEP)LEP Limitations May degrade vision, especially night-time Distorted color perception No single LEP protects ALL wavelengths NVG interference (physical and optical) Helmet interference, sensor readability, CBR/MOPP crew gear

17 Laser Eye Protection (LEP)LEP available in Spectacles or Visors LEP matched to laser threat in theater per OPNAV ANSI Z standard for eye protection for industry

18 Pre-Flight Crew ProceduresOPNAV 3710 : annual LEP / laser training Review reports of any laser activity in the area reported to ATC (concerts, pireps, intel) Consider Laser Eye Protection (LEP) based on theater threat intelligence, Ops guidance Discuss in-flight laser exposure procedures Carry small Amsler grid (if significant threat) LEP must be worn if “significant laser threat” exists (per OPNAV U)

19 In-Air Exposure ProceduresLook Away & shield eyes (don LEP if available) DO NOT rub the eyes – increases irritation Turn up instrument lights Mark the position, time, and report to ATC Unexposed co-pilot gets on instruments Query other crew members for exposure Self-examination using small print or Amsler grid (if available) ‘Self-triage’ vision able to read small print, check individual eyes, check pocket Amsler grid, nav charts, HUD or MFD for any visual defects Determine mission viability, if significant vision symptoms prevent safe continuance

20 Crew After-Landing ProceduresNotify Chain of Command Notify Flight Surgeon & Laser Safety System Officer Flight Surgeon eye exam as soon as practicable Complete HAZREP Complete FAA laser exposure web report Call DoD Laser Hotline (24/7) Toll-free: Call BUMED Laser Report Line:

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22 Tri-Service Laser Incident Reporting website: https://hpws.afrl.af.mil/dhp/OE/ESOHSC/laserinjury/ NAVY/USMC: BUMED report required:

23 Flight Surgeon ProceduresComplete the ‘Laser Incident Questionnaire’ (Appendix C of Laser Injury Guidebook) Obtain complete history of events List ocular symptoms Document LEP or eyewear worn (e.g. NVGs) Coordinate with Squadron Laser Safety Officer on reporting to avoid duplication

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25 Flight Surgeon Physical ExamVisual Acuity (with correction) Amsler Grid test Pupil exam Stereopsis testing Color Vision Slit Lamp – corneal abrasions/burns, lens opacity, conjunctival injection.

26 Flight Surgeon Exam and ActionsDilated Retinal Exam Evaluate for retinal changes, blood, burns, white lesions

27 Ophthalmology ConsultationDoes laser eye exam reveal significant visual or ocular findings? If yes, consult ASAP to ophthalmology or optometrist Navy/USMC: OPNAV (Laser Hazards Control Program): **ALL exposures get consult exam “immediate” or “urgent”** Make recommendation on Fitness for Aviation Duty or further medical management

28 Laser Exposure Aerospace Pearls99%+ of all exposures will not cause permanent injury– may return to flight immediately if no persistent symptoms, normal vision testing and normal exam. Laser Hotline and Web Report on ALL exposures Document medical follow-up in 1-3 days. Actual injuries or persistent symptoms: “Down” chit pending consultation Ophthalmology/Optometry consult “TODAY” (aerovac as needed)

29 Laser Injury GuidebookUnited States Air Force School of Aerospace Medicine Laser Injury Guidebook: Appendix C: Laser Incident Questionnaire Appendix D: Amsler grid

30 DoD Laser Injury Hotline & InfoHOTLINE Toll-free: https://hpws.afrl.af.mil/dhp/OE/ESOHSC/laserinjury/ USAFSAM Ophthalmology: NAMI Ophthalmology: Laser Safety Documents (unclassified): BUMED report:

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32 Questions?