Eye surgery, also known as ophthalmic or ocular surgery, treats various conditions affecting the eye. These procedures are performed by ophthalmologists, medical doctors specializing in eye care. Modern advancements have improved the safety and effectiveness of eye surgeries, offering solutions for a wide range of visual impairments and diseases.
Surgeries for Vision Correction
Refractive surgeries correct common vision problems like nearsightedness (myopia), farsightedness (hyperopia), and astigmatism by reshaping the cornea. LASIK, or Laser-Assisted In Situ Keratomileusis, is a widely performed procedure where a thin flap is created on the cornea with a femtosecond laser. An excimer laser then reshapes the underlying corneal tissue to correct the refractive error, and the flap is repositioned to heal naturally.
Photorefractive Keratectomy (PRK) is another laser-based option. It differs from LASIK by removing the outermost layer of the cornea, the epithelium, before using an excimer laser to reshape the corneal surface. A bandage contact lens is then placed on the eye while the epithelium regrows, leading to a slightly longer recovery period compared to LASIK. SMILE, or Small Incision Lenticule Extraction, is a newer laser vision correction for nearsightedness and astigmatism. This procedure uses a femtosecond laser to create a small, lens-shaped piece of tissue, called a lenticule, inside the cornea, which is then removed through a tiny incision, reshaping the cornea without creating a large flap.
For individuals not suitable for laser corneal surgeries due to high refractive errors or certain eye conditions, Refractive Lens Exchange (RLE) offers an alternative. This procedure involves removing the eye’s natural lens and replacing it with an artificial intraocular lens (IOL) that contains a customized prescription. RLE can address extreme nearsightedness or farsightedness, and also presbyopia, an age-related farsightedness, reducing or eliminating the need for glasses or contact lenses.
Cataract Surgery
Cataract surgery is a common ophthalmic procedure that addresses cataracts, cloudiness in the eye’s natural lens that impairs vision. During the surgery, the cloudy natural lens is removed and replaced with an artificial intraocular lens (IOL). This outpatient procedure takes less than an hour, with most patients returning home the same day.
Various types of IOLs are available, designed for different visual needs. Monofocal IOLs are a popular choice, providing clear vision at a single distance, usually set for far vision, requiring reading glasses for close-up tasks. Toric IOLs are a type of monofocal lens designed to correct astigmatism, an irregular curvature of the cornea, at the time of cataract surgery.
Multifocal IOLs, including trifocal lenses like the PanOptix IOL, provide clear vision at multiple distances—near, intermediate, and far—reducing or eliminating the need for glasses for most activities. Extended depth-of-focus (EDOF) IOLs provide a continuous range of vision, often spanning distance and intermediate ranges, with minimized glare and halos compared to some multifocal lenses. The Vivity IOL uses X-Wave technology to achieve this extended range, making it suitable for those who engage in detailed work or reading.
Glaucoma Surgery
Glaucoma surgery addresses conditions characterized by elevated intraocular pressure (IOP) that can damage the optic nerve, leading to vision loss. These surgeries reduce eye pressure by improving fluid drainage or decreasing fluid production. Trabeculectomy is a traditional procedure where a small opening is created in the sclera, the white part of the eye, to allow excess fluid to drain, forming a bleb under the eyelid.
Minimally Invasive Glaucoma Surgery (MIGS) procedures have gained popularity for treating mild to moderate glaucoma due to their lower risk and faster recovery. These procedures involve small incisions and enhance the eye’s natural drainage pathways. Examples include the implantation of tiny stents, such as the iStent, which creates a permanent opening through blockages in the eye’s drainage system to improve fluid outflow.
Laser treatments are also used for glaucoma. Selective Laser Trabeculoplasty (SLT) and Argon Laser Trabeculoplasty (ALT) both use a laser to target the trabecular meshwork, a tissue in the eye that helps drain fluid. SLT uses short pulses of low-energy laser light to stimulate cellular regeneration and improve fluid circulation through the meshwork, reducing IOP. ALT, while similar, uses a longer pulse duration that creates more thermal damage.
Retinal and Vitreous Surgeries
Surgeries involving the retina and vitreous humor address conditions affecting the back of the eye. The vitreous is a clear, gel-like substance that fills the middle of the eye. Vitrectomy is a microsurgical procedure to remove the vitreous gel, often when it is cloudy, filled with blood, or exerting traction on the retina. This procedure is used for conditions such as retinal detachment, macular holes, vitreous hemorrhage, and severe diabetic retinopathy.
Retinal detachment occurs when the light-sensitive tissue at the back of the eye pulls away from its supporting layers, which can lead to vision loss if not treated promptly. Several surgical techniques reattach the retina. Scleral buckling involves sewing a silicone band onto the sclera to gently indent the eye wall, bringing it closer to the detached retina and sealing any tears.
Pneumatic retinopexy is a less invasive option for certain types of retinal detachments. In this procedure, a gas bubble is injected into the vitreous cavity, which then floats to press against the detached area of the retina, allowing fluid to be pumped out from beneath it. Laser or cryotherapy is often used to seal the retinal tear permanently.
Corneal Surgeries
Corneal surgeries focus on conditions affecting the cornea, the transparent, dome-shaped front surface of the eye. Corneal transplant, also known as keratoplasty, involves replacing a diseased or damaged cornea with healthy donor tissue. Penetrating Keratoplasty (PKP) is a full-thickness corneal transplant where the central portion of the diseased cornea is removed and replaced with a matching donor cornea, secured with sutures.
Partial-thickness corneal transplants, such as Descemet’s Stripping Automated Endothelial Keratoplasty (DSEK) and Descemet’s Membrane Endothelial Keratoplasty (DMEK), are performed when only the innermost layer of the cornea, the endothelium, is affected. These procedures selectively replace the diseased endothelial layer, leaving the healthy outer corneal layers intact. DMEK involves transplanting a thinner layer of donor tissue compared to DSEK, offering a quicker visual recovery and lower risk of graft rejection.
Corneal cross-linking (CXL) is a procedure used to treat keratoconus, a progressive eye disease where the cornea thins and bulges into a cone-like shape. CXL involves applying riboflavin eye drops to the cornea, followed by exposure to ultraviolet (UV) light. This process strengthens the collagen fibers within the cornea, helping to halt or slow the progression of keratoconus and stabilize corneal shape.