Certain eye and vision issues benefit from surgery. There are multiple procedures doctors might consider to treat some conditions.

For refractive errors, LASIK surgery is a popular choice. (Learn More) This procedure is performed to improve vision, so people don’t have to rely on corrective lenses, like eyeglasses or contacts.

If cataracts are present, removing the cloudy lens surgically can help to improve vision. A similar surgery can be done for presbyopia. This is typically performed via a procedure that replaces the natural lens with a new one. (Learn More)

Glaucoma is a relatively common condition that can impact vision. There are different types of trabeculectomy surgeries doctors may consider. (Learn More) These surgeries help to relieve intraocular pressure and can prevent vision loss from glaucoma.

Other eye conditions may benefit from other surgical procedures. These procedures come in different forms, such as keratoplasty (Learn More) and keratotomy.(Learn More)

LASIK Surgery

patient receiving cataract surgery

LASIK is a type of laser eye surgery used to correct different types of refractive errors, including hyperopia, myopia, and astigmatism. The surgeon uses an excimer cold laser that is controlled by a computer to reshape the cornea.

There are four primary types of LASIK.

  • Waterfront-guided LASIK: This type utilizes measurements of how light goes through the eye to target individual vision and eye anatomy.
  • All-laser LASIK: This type uses a femtosecond laser in place of a surgical blade.
  • Wavefront-optimized or wavefront-guided LASIK: This type uses detailed cornea curvature measurements to preserve the front surface of the eye’s natural aspheric shape.
  • Topography-guided LASIK: This type uses mapping technologies for a more tailored treatment.

To perform LASIK, the surgeon numbs the eyes using eyedrops so the patient is comfortable. They then use either a surgical blade or a femtosecond laser to create a corneal flap. The surgeon removes a thin tissue layer so the cornea is flattened.

To complete the procedure, the flap is put back into place. No stitches are necessary to keep the flap in place as it reattaches by itself.

Refractive Lens Exchange Surgery

This surgery is performed for presbyopia. It can also be done for severe hyperopia.

It can alleviate the need for corrective lenses because it replaces the natural lens in the eye with an artificial one. The artificial lens allows for sharper focus.

The procedure is nearly identical to cataract surgery. For the procedure, the natural lens is removed through tiny incisions, and the new lens is put into its place.

Cataract Surgery

woman with cataract

When a cataract is present, the natural lens becomes cloudy. This can cause vision to become hazy and blurry, and colors to appear less vibrant.

The purpose of cataract surgery is to remove this lens and replace it with an artificial one that is clear. There are some basic steps that a surgeon follows.

  • They numb the eye with eyedrops.
  • They make tiny incisions close to the cornea’s edge.
  • They break up the lens and remove it.
  • They insert the new lens.

Trabeculectomy

This surgery is performed to treat glaucoma by helping to lower eye pressure. It can be used alone or with eyedrops that help to lower eye pressure.

There are different types of trabeculoplasty surgery.

  • Traditional trabeculoplasty
  • Argon laser trabeculoplasty
  • Micropulse diode laser trabeculoplasty (MDLT)
  • Selective laser trabeculoplasty

The general premise is the same, no matter which type of trabeculectomy is performed. The selective laser type is often considered first.

On average, this procedure is successful for about 80 percent of people who undergo it. It helps to alleviate eye pressure by approximately 20 to 30 percent, on average.

The beneficial effects of the procedure last for three to five years for most people. Once the effects start to wear off, selective laser trabeculoplasty can be repeated.

This type of surgery is usually considered before other surgeries are used on people with glaucoma. The following basic steps are typically followed:

  • The eye is numbed with eyedrops.
  • A lens and special microscope are used to guide the laser.
  • Small burns are made into the eye’s trabecular meshwork.
  • The doctor inputs eyedrops to prevent an immediate rise in eye pressure.

Keratotomy Procedures

Keratotomy involves cutting the cornea, often to improve vision. There are two primary types.

  • Astigmatic keratotomy
  • Radial keratotomy

In the U.S., radial keratotomy is rarely used anymore because there are better refractive surgeries.

When keratotomy surgery is performed, it is usually the astigmatic type. The purpose is to correct astigmatism.

When someone has an astigmatism, their cornea takes on a football shape. During the procedure, the doctor makes up to two incisions into the area of the cornea that is the steepest. Once the incisions are made, the cornea can relax, causing its shape to become rounder. This reduces the level of astigmatism and associated vision issues.

astigmatism vs normal vision graphic

If an astigmatism is mild, this surgery may eliminate the need to wear corrective lenses. If the astigmatism is severe, the person might still need corrective lenses, though they may only require a lower prescription.

Keratoplasty Surgeries

Keratoplasty is a surgery that replaces the natural cornea. There are different techniques a surgeon might consider.

  • Penetrating keratoplasty
  • Conductive keratoplasty
  • Laser thermal keratoplasty

There are also different levels of this surgery.

  • Full-thickness corneal transplant: This procedure involves removing and replacing the entire cornea. Once the surgery is complete, people may need a year or more to experience complete restoration of their vision.
  • Partial-thickness corneal transplant: This procedure is performed when only the middle and front corneal layers are damaged. The doctor removes these layers and leaves the endothelial layer untouched.
  • Endothelial keratoplasty: When the endothelium layer of the cornea is damaged, this procedure might be considered. During the surgery, the doctor will remove the damaged cells from the Descemet’s membrane component of the cornea. This involves a small incision that the doctor works through. Once the damaged areas are removed, new tissue replaces them. The doctor can leave the majority of the cornea untouched.

Intracorneal Ring

This surgical procedure might be considered for the following reasons:

  • Keratoconus, a progressive eye disease in which the cornea bulges into a cone-like form
  • Low myopia, ranging from negative 1.0 to 3.0 D
  • Post-LASIK keratectasia, which involves a weakened cornea

keratoconus

This refractive surgery involves creating a small incision in the cornea. The doctor then inserts the rings. These are made from plastic and have a crescent shape. They spare the central cornea area and go onto the cornea’s outer edge. They cause the cornea to flatten so when light enters the eye, it can focus on the retina properly.

Eye surgery is not uncommon. There are several types a doctor might discuss with you, depending on the eye issues you are experiencing.

As with all surgeries, there are pros and cons to each procedure. Take the time to understand how each could benefit your particular situation before moving forward.

References

Selective Laser Trabeculoplasty as Primary Glaucoma Therapy. (May 2018). Glaucoma Research Foundation.

Laser Trabeculoplasty for Glaucoma. University of Michigan.

Corneal Transplant Surgery Options. (November 2018). American Academy of Ophthalmology.

Intrastromal Corneal Ring Segments (ICRS). (March 2018). American Academy of Ophthalmology.

Radial Keratotomy in the United States. American Academy of Ophthalmology.

Astigmatism. American Optometric Association.

Cataract Surgery. (November 2018). American Academy of Ophthalmology.

Refractive Lens Exchange (Lens Replacement Surgery). All About Vision.

Types of Eye Surgery for Refractive Errors. University of Rochester Medical Center.