There are many different types of eye surgeries, treating a wide array of eye conditions. Some of these conditions include glaucoma, cataracts, retinal tears and detachments, wet AMD, diabetic retinopathy, and even nearsightedness and farsightedness.
In addition, eye surgeries address issues in the muscles around the eye or the cornea — the clear structure at the front of the eye. The cornea can lose its transparency and requires a transplant. Eye muscle surgery is sometimes necessary to align the eyes and reduce double vision.
Tumors can develop in and around the eye and may need to be surgically removed. Surgery can also be done around the eyes, such as to repair eyelids.
1. Age-Related Macular Degeneration (AMD)
Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss in older patients. Dilated funduscopic findings are diagnostic; color photographs, fluorescein angiography, and optical coherence tomography assist in confirming the diagnosis and in directing treatment. Treatment is with dietary supplements, intravitreal injection of antivascular endothelial growth factor drugs, laser photocoagulation, photodynamic therapy, and low-vision devices
Dry AMD
The loss of central vision occurs over years and is painless, and most patients retain enough vision to read and drive. Central blind spots (scotomas) usually occur late in the disease and can sometimes become severe. Symptoms are usually bilateral.
Funduscopic changes include the following:
- Changes in the retinal pigment epithelium
- Drusen
- Areas of chorioretinal atrophy
Wet AMD
Rapid vision loss, usually over days to weeks, is more typical of wet AMD. The first symptom is usually visual distortion, such as a central blind spot (scotoma) or curving of straight lines (metamorphopsia). Peripheral vision and color vision are generally unaffected; however, the patient may become legally blind (< 20/200 vision) in the affected eye, particularly if AMD is not treated. Wet AMD usually affects one eye at a time; thus, symptoms of wet AMD are often unilateral.
Funduscopic changes include the following:
- Subretinal fluid, appearing as localized retinal elevation
- Retinal edema
- Gray-green discoloration under the macula
- Exudates in or around the macula
- Detachment of retinal pigment epithelium (visible as an area of retinal elevation)
- Subretinal hemorrhage in or around the macula
PAUL PARKER/SCIENCE PHOTO LIBRARY
Diagnosis of AMD
- Funduscopic examination
- Color fundus photography
- Fluoresceinangiography
- Optical coherence tomography
Both forms of age-related macular degeneration (AMD) are diagnosed by funduscopic examination. Visual changes can often be detected with an Amsler grid. Color photography and fluorescein angiography are done when findings suggest wet AMD. Angiography shows and characterizes subretinal choroidal neovascular membranes and can delineate areas of geographic atrophy. Optical coherence tomography (OCT) aids in identifying intraretinal and subretinal fluid and can help assess response to treatment.
Treatment of AMD
- Dietary supplements for high-risk dry or unilateral wet age-related macular degeneration (AMD)
- Intravitreal antivascular endothelial growth factor drugs or laser treatments for wet AMD
- Supportive measures
Dry AMD
There is no way to reverse damage caused by dry AMD. Patients with extensive drusen, pigment changes, and/or geographic atrophy can reduce the risk of developing advanced AMD by 25% by taking daily supplements of the following:
- Zinc oxide80 mg
- Copper2 mg
- Vitamin C 500 mg
- Vitamin E400 IU units
- Lutein 10 mg/zeaxanthin 2 mg (or beta-carotene 15 mg or vitamin A28,000 units for patients who have not smoked)
In current and former smokers, beta-carotene can increase the risk of lung cancer. Substitution of beta-carotene with lutein plus zeaxanthin has been shown to have comparable efficacy (1). Therefore, such a substitution should be considered in current or former smokers. Beta-carotene yellows the skin in some patients. The zinc component of these supplements increases risk of hospitalization for genitourinary tract disorders. Reducing cardiovascular risk factors as well as regularly eating foods high in omega-3 fatty acids and dark green leafy vegetables may help slow disease progression; however, recent large trials have not shown that taking supplements of omega-3 fatty acids reduces disease progression.
Wet AMD
Patients with unilateral wet AMD should take the daily nutritional supplements that are recommended for dry AMD to reduce the risk of AMD-induced vision loss in the other eye. The choice of other treatments depends on the size, location, and type of neovascularization. Intravitreal injection of antivascular endothelial growth factor (anti-VEGF) drugs (usually ranibizumab, bevacizumab, or aflibercept) can substantially reduce the risk of vision loss and can help restore reading vision in up to one third of patients. Recently, an implantable port delivery system for ranibizumab became available for the treatment of wet AMD (2). This is a surgically placed permanent refillable ocular implant that continuously delivers ranibizumab into the vitreous and can be refilled repeatedly.
In 2020, intravitreal brolucizumab became available for the treatment of wet AMD (3); however, early reports (4) suggest a higher incidence of adverse events with this drug than with other intravitreal anti-VEGF injections, including intraocular inflammation, retinal artery occlusion, and vasculitis.
In a small subset of patients, thermal laser photocoagulation of neovascularization outside the fovea may prevent severe vision loss. Photodynamic therapy, a type of laser treatment, also helps under specific circumstances. Corticosteroids (eg, triamcinolone) are sometimes injected intraocularly along with an anti-VEGF drug. Other treatments, including transpupillary thermotherapy, subretinal surgery, and macular translocation surgery, are seldom used.
Age-related macular degeneration is an eye disease that affects your central vision. It damages the macula, the part of your retina that lets you see fine details. In the United States, macular degeneration is the most common cause of complete vision loss in older people.
Furthermore, macular degeneration has two main types— wet and dry.
- Wet AMD occurs when abnormal blood vessels form under the macula and leak fluid and blood. It damages the macula and impairs central vision.
- The macula becomes thinner and drier with dry AMD as small yellow deposits, drusen, build up under it. About 70% to 90% of cases of AMD are dry rather than wet.
Symptoms of AMD
- Blurry or fuzzy vision.
- Difficulty recognizing familiar faces.
- Black or dark spots near the center of your field of vision.
- Straight lines appear curvy or wavelike.
It may take some time for these symptoms to become evident. While there is no cure, treatments help slow the disease’s progression.
Surgical Treatments for Age-Related Macular Degeneration
- Anti-VEGF injections and drugshelp slow the growth of abnormal blood vessels in the retina and reduce leakage.
- Photodynamic Laser Therapy(PDT) breaks down abnormal blood vessels on the back of the eye with a special laser.