Types of Eye Surgery
In this blog post, I will try to cover the wide variety of eye surgeries. Eye surgery types are also called ocular surgeries, referring to the eye and surrounding tissues. There are laser eye surgery types, as lasers are extremely precise and have many applications in eye surgery
What Are Different Types of Eye Surgery?
There is an extraordinarily long list of different types of eye surgery. They generally can be categorized with regard to the part of the eye that is being operated on. The type of eye surgery recommended will depend on your diagnosis, the anatomical structure affected, the surgeon, and his or her experience, as well as the technology available. I’ll start with the different ophthalmology surgeries, but first will describe the training required to perform ophthalmological surgery. To become an ophthalmologist, one must complete an undergraduate degree, a medical degree, then an internship year and usually at least three years of ophthalmological surgery training. Ophthalmologists may then train further in a subspecialty such as refractive surgery, cornea, cataract, Neuro-ophthalmology, orbit, oculoplastics, glaucoma, pediatric ophthalmology and strabismus, vitreoretinal surgery, uveitis, or medical retina.
Different Types of Eye Surgery Listed Anatomically
Cornea: The field of cornea specifically involves the surgical treatment of corneal disease. It includes surgeries such as full thickness penetrating keratoplasty, DSAEK, DMEK, which are partial thickness corneal transplants and a relatively new surgery that allows the patient to keep the healthy part of their cornea, whereas previous generations of surgeons treated only with a full-thickness corneal transplant, which was more complex and had more potential for complications. A corneal subspecialist also may treat inflammatory conditions of the cornea and anterior segment. Most corneal surgeons also do a lot of cataract surgery. The need for corneal transplant’s has decreased over the years due to better techniques of cataract surgery.
Refractive Surgery: A refractive surgery may use different techniques involving either the cornea or the natural crystalline lens of the eye to change the focusing power of the eye and allow a person to see clearly without glasses or contact lenses. The types of ophthalmological surgery that a refractive surgeon performs generally are: LASIK, PRK, SMILE, ICL, refractive lens exchange and cataract surgery. This is also a rapidly evolving field that has additional techniques and refined techniques to allow a safer quicker and more comfortable procedure. LASIK is currently the most frequently performed surgery that a refractive surgeon performs, but the patient age, refractive error, anatomy, vocation and needs all affect the recommendation for the different types of eye surgery
While many ophthalmologists perform cataract surgery, some ophthalmologists specialize in only cataract surgery. A cataract surgeon‘s job is to diagnose and treat cataract, a clouding of the natural lens of the eye. The lens is replaced with an artificial lens. Artificial lenses traditionally have been monofocal, meaning that postoperatively a patient could either elect to have their eyes focused for distance vision, near vision, or one of each so that they could see relatively well at distance and near. Over the past 10 to 15 years research has focused on creating a multifocal intraocular lens that allows a patient to see both distance and near objects without any glasses. This is an amazing and quickly evolving field. Researchers are trying to come up with better and better lenses that have better optical quality, better depth of field and range of focus so that patients can see as well as they could when they were young and didn’t need any glasses at all. It’s super exciting and the most commonly performed surgery in the world. Over 4 million cataract surgeries are performed in the United States every year. It has come a long way from “couching“ which was done in the ancient world and often resulted in blindness. Current techniques have no needles, no stitches, no blades, no pain and often no postoperative drops. Lasers are capable of creating the incisions, breaking up the natural lens.
A glaucoma sub-specialist performs surgeries to reduce the pressure of the eye that causes progressive damage to the optic nerve. The types of surgery have evolved from primitive techniques such as iridencleisis (not performed by modern surgeons) to a filtration procedure called trabeculectomy to allow the eye to drain fluid through a non+healing incision at the edge of the cornea. This surgery left a lot to be desired, with pressure that was too low, too high, got infected, or lost efficacy over time. Modern glaucoma surgery is trending to a much more sophisticated MIGS, or minimally invasive glaucoma surgery where a small micro-shunt or stent is placed inside the anterior chamber to allow a more controlled drainage of fluid from the eye and reduced intraocular pressure.
Vitreoretinal surgery is the branch of ophthalmology that diagnoses and surgically and medically treats pathology of the vitreous (the gel that fills the central space of the eye) and the retina. The techniques and medications used in the treatment of macular degeneration, diabetic retinal disease, retinal detachments, inflammation of the eye have improved dramatically in the past 25 years and more. It’s amazing!
Pediatric Ophthalmology and Strabismus
Pediatric ophthalmologists treat imbalances in the eye muscles that cause the eyes to turn out or in, up or down, so that the eyes are not aligned properly. The most commonly performed extraocular muscle surgery performed is called recess and resect, in which one eye muscle is removed from the eye and reattached farther back (recess) so it’s a bit looser and the eye muscle on the other side of the eye is cut slightly shorter and reattached at the same spot (resect) so it’s a bit tighter. It’s a delicate surgery which allows the eyes to see a single image rather than two images.
An oculoplastic surgeon is an 0phthalmologist that has completed an ophthalmology residency but goes on to further subxspecialize in the eyelids and lacrimal apparatus. People who have conditions where the tears of the eye do not drain properly can be potentially corrected by an oculoplastic surgeon. There is a tiny drainage system in the corners of our eyes by our nose that allows tears to drain. If someone has eyelids that turn out or in, or if the drain is blocked by tumor, inflammation, or trauma, they can have continuous tearing that is extremely annoying. This potentially be corrected by an oculoplastic surgeon who creates or restores the drain so that a person is able to live without constant tearing of their eyes. Eyelids also have multiple problems such as drooping, turning out, turning in, or being too loose. Trauma or cancer such as basal cell carcinoma of the skin can require removal of the tumor and leave someone with a defect of their eyelids. Sometimes an oculoplastic surgeon will use a skin graft or a technique to move skin over the defect and create a functionally and aesthetically pleasing result. Also an amazing specialty that continues to develop techniques that are often modified from general plastic surgeons. Thank you colleagues!
Eye surgeries are amazing to watch and perform. They allow a patient to regain full use of their eyes, and save vision. I’m continually amazed at the innovation and progress that has occurred in my career. Just when I think it can’t get any better, newer and better techniques and technology is used to better/help, our patients. I’m privileged and humbled to be a part of this wonderful medical specialty.
-Dr. Matthew Sharpe