OPHTHAMOLOGY

Laser Eye Surgery

Laser eye surgery is an umbrella term for several eye surgeries used to correct refractive errors (i.e., how your eye focuses light). The most common types of laser eye surgery include LASIK, PRK, LASEK and EpiLASIK.

Each of the four laser eye surgery procedures below uses the same special laser, called an “excimer” laser, to reshape the cornea. This is what corrects vision. But laser eye surgery can vary in the specifics of the procedure, the recovery time, which surgical instruments are used and your patient candidacy. You might be a better candidate for PRK, for instance, than for LASIK.

Your ophthalmologist should be able to determine from a comprehensive, laser-eye-surgery-specific eye exam which procedure is best for you. His recommendation will follow which procedure he thinks will give you the best possible outcome. Most patients achieve 20/20 or better vision after laser eye surgery.

1. LASIK (Laser in Situ Keratomileusis)

LASIK is the most common laser eye surgery. LASIK starts with the creation of a thin flap in the cornea. Your surgeon uses a blade or a laser to make this flap. The laser is considered more desirable by some doctors because of its precision, such as fewer visually significant complications ; however, all-laser LASIK costs a bit more than LASIK that uses a blade. Once the flap is created, the excimer laser is used to reshape the cornea, which corrects the refractive error.

2. PRK (Photorefractive Keratectomy)

PRK is the second most common type of laser eye surgery. PRK starts with the removal of a portion of surface of the cornea or epithelial tissue. There is therefore no need for flap creation, and the removed tissue grows back. Some patients prefer PRK because they don’t want a corneal flap, and some patients are better candidates for PRK eye surgery than for LASIK (for instance, people with thin corneas). Once the epithelium is removed, a laser is used to reshape the cornea. The laser is the same (i.e., excimer) as the one used in LASIK.

The PRK recovery period is a bit longer than that of LASIK. For more on PRK, click here.

3. LASEK (Laser Epithelial Keratomileusis)

LASEK is similar to LASIK and PRK, but it starts with the application of alcohol to the corneal epithelium. This loosens the outermost corneal cells and allows the surgeon to move them out of the way, without removing them, for the laser procedure. After reshaping the stroma with the excimer laser , the surgeon can replace the sheet of epithelial cells and put a contact lens to let it heal.

LASEK can be a good option for patients with thin corneas. To learn more about LASEK, click here.

4. Epi-LASIK (Epithelial Laser in Situ Keratomileusis)

Epi-LASIK starts the way LASIK does, except the flap is thinner and made only of epithelial tissue. Once the flap is created, it is moved aside, just enough that the surgeon can reshape the stroma underneath with the excimer laser. The flap of epithelium is then replaced and covered with a contact-lens bandage to heal. Some consider Epi-LASIK a hybrid of LASIK and LASEK. Some surgeons believe Epi-LASIK is a good option because the flap exists only in the epithelium layer, and because there’s no alcohol used during the procedure.

Pediatric Opthalmology

A pediatric ophthalmologist is a medical and surgical doctor. All ophthalmologists have training in children’s eye disorders, but the pediatric ophthalmologist has additional training, experience, and expertise in examining children, and has the greatest knowledge of possible conditions that affect the pediatric patient and his/her eyes. Neurologic development of vision occurs up until approximately age 12 years. Misalignment of the eyes (strabismus), uncorrected refractive error (myopia, hyperopia, and astigmatism), and asymmetry of refractive error (anisometropia) between the two eyes can negatively affect this development and cause amblyopia (“lazy eye”). If these conditions are diagnosed and treated early, good vision can develop and can be maintained. Certain diseases elsewhere in the body, such as diabetes, can affect the eyes, and the pediatric ophthalmologist addresses these

Medical Treatments

  • Prescriptions for glasses and/or contact lenses.
  • Amblyopia (“lazy eye”) therapy including glasses, patching and pharmacologic treatment.
  • Topical and or/systemic therapy for eye infections, chalazia, glaucoma, blocked tear ducts, and inflammation on the eye or in the eye. Medicines include antibiotics, antivirals and steroids.

Surgical Procedures

  • Probe and Irrigation for congenital nasolacrimal duct obstruction (blocked tear duct).
  • Excision of chalazia.
  • Eye muscle surgery for strabismus.
  • Pediatric cataract extraction including use of intraocular lenses (IOLs).

Additional treatments/surgeries performed by some include retinal examination and laser treatment of retinopathy of prematurity (ROP), surgical removal of pediatric orbital tumors/lesions, and surgery for glaucoma or ptosis (drooping eyelid) in the child.

Cataract Surgery

A cataract is a clouding of the lens inside the eye, causing vision loss that cannot be corrected with glasses, contact lenses or corneal refractive surgery like LASIK.

In cataract surgery, the lens inside your eye that has become cloudy is removed and replaced with an artificial lens (called an intraocular lens, or IOL) to restore clear vision.
The procedure typically is performed on an outpatient basis and does not require an overnight stay in a hospital or other care facility.

Most modern cataract procedures involve the use of a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, which are then gently removed from the eye with suction.

This procedure, called phacoemulsification or “phaco,” can be performed with smaller incisions than previous surgical techniques for cataract removal, promoting faster healing and reducing the risk of cataract surgery complications, such as a retinal detachment.

After all remnants of the cloudy lens have been removed from your eye, the cataract surgeon inserts a clear intraocular lens, positioning it securely behind the iris and pupil, in the same location your natural lens occupied. (In special cases, an IOL might be placed in front of the iris and pupil, but this is less common.)

The surgeon then completes the cataract removal and IOL implantation procedure by closing the incision in your eye (a stitch may or may not be needed), and a protective shield is placed over the eye to keep it safe in the early stages of your cataract surgery recovery.

Refractive Corneal Surgery

Refractive error, such as nearsightedness (myopia), farsightedness (hyperopia), astigmatism or presbyopia, refractive surgery is a method for correcting or improving your vision. There are various surgical procedures for correcting or adjusting your eye’s focusing ability by reshaping the cornea, or clear, round dome at the front of your eye. Other procedures involve implanting a lens inside your eye. The most widely performed type of refractive surgery is LASIK (laser-assisted in situ keratomileusis), where a laser is used to reshape the cornea.

For people who are nearsighted, certain refractive surgery techniques will reduce the curvature of a cornea that is too steep so that the eye’s focusing power is lessened. Images that are focused in front of the retina, due to a longer eye or steep corneal curve, are pushed closer to or directly onto the retina following surgery.

Farsighted people will have refractive surgery procedures that achieve a steeper cornea to increase the eye’s focusing power. Images that are focused beyond the retina, due to a short eye or flat cornea, will be pulled closer to or directly onto the retina after surgery.

Astigmatism can be corrected with refractive surgery techniques that selectively reshape portions of an irregular cornea to make it smooth and symmetrical. The result is that images focus clearly on the retina rather than being distorted due to light scattering through an irregularly shaped cornea.

Refractive surgery might be a good option for you if you:

  • Want to decrease your dependence on glasses or contact lenses;
  • Are free of eye disease;
  • Accept the inherent risks and potential side effects of the procedure;
  • Understand that you could still need glasses or contacts after the procedure to achieve your best vision;
  • Have an appropriate refractive error.

There is no universally-accepted, best method for correcting refractive errors. The best option for you should be decided after a thorough examination and discussion with your ophthalmologist. If you are considering refractive surgery, you and your Eye M.D. can discuss your lifestyle and vision needs to determine the most appropriate procedure for you.

Glaucoma

Glaucoma is a disease that damages your eye’s optic nerve. It usually happens when fluid builds up in the front part of your eye. That extra fluid increases the pressure in your eye, damaging the optic nerve.

Here are the signs of an acute angle-closure glaucoma attack:

  • Your vision is suddenly blurry
  • You have severe eye pain
  • You have a headache
  • You feel sick to your stomach (nausea)
  • You throw up (vomit)
  • You see rainbow-colored rings or halos around lights

Treatment for Glaucoma

Glaucoma is usually controlled with eyedrop medicine. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle.

Laser Surgery

There are two main types of laser surgery to treat glaucoma. They help aqueous drain from the eye. These procedures are usually done in the ophthalmologist’s office or an outpatient surgery center.

Trabeculoplasty

This surgery is for people who have open-angle glaucoma. The eye surgeon uses a laser to make the drainage angle work better. That way fluid flows out properly and eye pressure is reduced.

Iridotomy

This is for people who have angle-closure glaucoma. The ophthalmologist uses a laser to create a tiny hole in the iris. This hole helps fluid flow to the drainage angle.

Eye Cancer

An eye cancer starts in the eye. There are Two types of cancers can be found in the eye.

Primary Intraocular Cancer

It start inside the eyeball. In adults, melanoma is the most common primary intraocular cancer, followed by primary intraocular lymphoma. These 2 cancers are the focus of this document.

In children, retinoblastoma (a cancer that starts in cells in the retina) is the most common primary intraocular cancer, and medulloepithelioma is the next most common (but is still extremely rare). These childhood cancers are discussed in Retinoblastoma.

Secondary Intraocular Cancers

It start somewhere else in the body and then spread to the eye. These are not truly “eye cancers,” but they are actually more common than primary intraocular cancers. The most common cancers that spread to the eye are breast and lung cancers. Most often these cancers spread to the part of the eyeball called the uvea. For more information on these types of cancers, see our documents on them

For Treatment of Eye Cancer refer to Oncology Page

Neuro Ophthalmology

Neuro-ophthalmology is an academically-oriented subspecialty that merges the fields of neurology and ophthalmology, often dealing with complex systemic diseases that have manifestations in the visual system. Neuro-ophthalmologists initially complete a residency in either neurology or ophthalmology, then do a fellowship in the complementary field. Since diagnostic studies can be normal in patients with significant neuro-ophthalmic disease,[1] a detailed medical history and physical exam is essential, and neuro-ophthalmologists often spend a significant amount of time with their patients.

Common pathology referred to a neuro-ophthalmologist includes afferent visual system disorders (e.g. optic neuritis, optic neuropathy, papilledema, brain tumors or strokes) and efferent visual system disorders (e.g. anisocoria, diplopia, ophthalmoplegia, ptosis, nystagmus, blepharospasm, seizures of the eye or eye muscles, and hemifacial spasm)

Diabetic Retinopathy

Diabetic retinopathy is a condition that occurs in people who have diabetes. It causes progressive damage to the retina, the light-sensitive lining at the back of the eye. Diabetic retinopathy is a serious sight-threatening complication of diabetes.

Diabetes interferes with the body’s ability to use and store sugar (glucose). The disease is characterized by too much sugar in the blood, which can cause damage throughout the body, including the eyes.

The condition usually affects both eyes. The longer a person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness.

Symptoms of diabetic retinopathy include:

  • Seeing spots or floaters
  • Blurred vision
  • Having a dark or empty spot in the center of your vision
  • Difficulty seeing well at night

Often the early stages of diabetic retinopathy have no visual symptoms. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

Treatment for Retinopathy

Treatment of diabetic retinopathy varies depending on the extent of the disease. People with diabetic retinopathy may need laser surgery to seal leaking blood vessels or to discourage other blood vessels from leaking. People with advanced cases of diabetic retinopathy might need a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous. Surgery may also be needed to repair a retinal detachment.

Dry Eye Treatment

Dry eye syndrome is a chronic and typically progressive condition. Depending on its cause and severity, it may not be completely curable. But in most cases, dry eyes can be managed successfully, usually resulting in noticeably greater eye comfort, fewer dry eye symptoms, and sometimes sharper vision as well.

Because dry eye disease can have a number of causes, a variety of treatment approaches are used.

The following is a list of dry eye treatments that are commonly used by eye doctors to reduce the signs and symptoms of dry eyes. Your eye doctor may recommend only one of these dry eye treatments or a combination of treatments, depending on the cause(s) and severity of the condition.

  • Artificial Tears
  • Restasis
  • Xiidra
  • Steroid Eye Drops
  • Lacrisert
  • Punctal Plugs
  • Meibomian Gland Expression
  • Warm Compresses
  • LipiFlow
  • Intense Pulsed Light
  • Nutritional Supplements
  • Home Remedies for Dry Eyes

Retinal Detachment

This serious eye condition happens when your retina — a layer of tissue at the back of your eye that processes light — pulls away from the tissue around it. Since the retina can’t work properly when this happens, you could have permanent vision loss if you don’t get it treated right away.

You’re more likely to get one if you:

  • Are severely nearsighted
  • Have had an eye injury or cataract surgery
  • Have a family history of retinal detachment

A detached retina doesn’t hurt. It can happen with no warning at all. But you might notice:

  • Flashes of light
  • Seeing lots of new “floaters” (small flecks or threads)
  • Darkening of your peripheral (side) vision

If you have any of those symptoms, contact your eye doctor immediately. Sometimes it comes before full detachment. It usually has the same symptoms. If your retina gets torn, the fluid inside your eye can leak underneath and separate the retina from its underlying tissue. That’s retinal detachment.

Treatment Retinal Detachment

There are several options:

Laser (thermal) or Freezing (cryopexy)

Both methods can repair a tear if it is diagnosed early enough. The procedures are often done in the doctor’s office.

Pneumatic Retinopexy

This works well for a tear that’s small and easy to close. The doctor injects a tiny gas bubble into the vitreous, a clear, gel-like substance between your lens and retina. It rises and presses against the retina, closing the tear. She can use a laser or cryopexy to seal the tear.

Scleral Buckle

In this surgical procedure, the doctor sews a silicone band (buckle) around the white of your eye (she’ll call it the sclera). This pushes it toward the tear until it heals. This band is invisible and is permanently attached. Laser or cryo treatment can seal the tear.

Vitrectomy

This surgery is used to repair large tears. The doctor removes the vitreous and replaces it with a saline solution. Depending on the size of the tear, she might use various combinations of vitrectomy, buckle, laser, and gas bubble to repair your retina.

INTACS

Intacs is the trademark name for micro-thin prescription inserts which were previously used as a form of refractive surgery in the treatment of low levels of myopia or nearsightedness, but has recently received FDA approval for keratoconus. Intacts for KeratoconusIntacs are thin plastic, semi-circular rings inserted into the mid layer of the cornea. When inserted in the keratoconus cornea they flatten the cornea, changing the shape and location of the cone. The placement of Intacs remodels and reinforces the cornea, eliminating some or all of the irregularities caused by keratoconus in order to provide improved vision. This can improve uncorrected vision, however, depending on the severity of the KC, glasses or contact lenses may still be needed for functional vision.

Vitrectomy

Vitrectomy is a surgery to remove the vitreous gel from the middle of the eye camera.gif. It may be done when there is a retinal detachment or if blood in the vitreous gel (vitreous hemorrhage) does not clear on its own. Removing the vitreous gel gives your eye doctor better access to the back of the eye. Vitrectomy is done by an eye doctor (ophthalmologist) who has special training in treating problems of the retina.

During surgery, the doctor uses small tools to remove the vitreous gel. Then the doctor may treat other eye problems, such as a retinal detachment, vitreous hemorrhage, scar tissue on the retina, or tears or holes in the macula.

At the end of the surgery, the doctor may inject an oil or gas bubble into the eye. This lightly presses the retina against the wall of the eye. If an oil bubble is used, the doctor will need to remove the oil after the eye has healed.

Uveitis

Uveitis is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Uveitis is an ophthalmic emergency and requires a thorough examination by an optometrist or ophthalmologist and urgent treatment to control the inflammation.

Corneal Transplant

If your cornea no longer lets light enter your eye properly because of scarring or disease, you may need a transplant. Your doctor will call it a keratoplasty. During the procedure, an eye surgeon removes a portion of the cornea and replaces it with a new section from a donor.

This clear tissue covers the front of each eye. Light passes through it to enter your eye, then goes through your pupil (the dark spot at the center of the eye), and then through the lens.