Types of Eye Surgery: A List of Vision Correction Procedures

There are several different types of eye surgery that can improve your vision. They range from cosmetic treatments to improve a refractive error like nearsightedness to medically necessary vision treatments that prevent blindness or slow degenerative diseases.

Below, we cover the most common forms of eye surgery.

Types of Eye Surgery to Improve Vision & Reduce Degenerative Vision Diseases

Cataract surgery

This procedure replaces the natural lens of your eye with an artificial lens. It is typically performed once a cataract becomes large enough that your vision is significantly obscured, usually several years or decades after you receive your initial cataract diagnosis.

The artificial lens is called an intraocular lens (IOL). Typically, the IOL improves your vision, but not to 20/20. You may not be able to see close or far distances, but your middle vision should improve.

Although cataract surgery requires several weeks of healing time, this is an outpatient procedure. You may be asked not to eat any solid food for up to six hours before the surgery, but you will not undergo general anesthesia. Instead, you will receive numbing eye drops.

Your ophthalmologist can create incisions in your cornea to remove the damaged lens and replace it with the artificial lens. The incision is considered “self-sealing” since it will be created with a laser.

LASIK

This is one of the simplest and most popular eye surgeries in the world, created to improve vision in people who have refractive errors like astigmatism, farsightedness, and nearsightedness. People with nearsightedness, or myopia, are most likely to benefit from this procedure, but improvements in the LASIK process mean that people with other refractive errors can benefit too.

This operation was approved by the Food and Drug Administration (FDA) in 1999. In the 30 years since, more than 90 percent of LASIK patients report high levels of satisfaction with their results.

LASIK takes about 15 minutes per eye to perform, including adding numbing eye drops and replacing the corneal flap after reshaping. Most people can return to work or school the day after the surgery, although you should wait for a few days or weeks before resuming moderate or vigorous activities.

Glaucoma surgery

The first line of defense in slowing glaucoma’s progression after diagnosis is using medicated eye drops. However, some types of glaucoma and high eye pressure that does not respond to eye drops can benefit from glaucoma surgery options.

Trabeculoplasty

This is a laser surgery that treats open-angle glaucoma by opening the drainage angle further.

Trabeculectomy

This procedure requires an operating room and sedation. Your eye surgeon will create a small flap in the sclera, or the white of your eye. They will then make a bubble, or pocket, in the conjunctiva termed a filtration bleb. This will be hidden beneath your upper eyelid so it is not visible, but it will drain aqueous humor out of the eye, so surrounding tissue absorbs it.

Drainage devices

If the eye cannot drain on its own with minor surgical options, your ophthalmologist may need to insert a drainage implant to send aqueous humor into a special reservoir, where it is then absorbed by your eye’s blood vessels.

Corneal transplant

Damage or disease may change your cornea so you cannot see. Your ophthalmologist may recommend a corneal transplant. There are different types of corneal transplant surgery.

Full thickness corneal transplant

If both the inner and outer corneal layers are damaged, your ophthalmologist will perform a penetrating keratoplasty (PK)to remove the damaged tissue and replace your cornea with a donor cornea. Be sure to follow your surgeon’s recovery and care advice to reduce the risk of infection, scar tissue, and organ rejection.

Partial thickness corneal transplant

This is the preferred treatment for damaged corneas, determining which layers of the organ are healthy and which are damaged, and then replacing only the damaged tissue with donor tissue.

Endothelial keratoplasty

The innermost layer of the cornea is the endothelium. If this tissue is damaged rather than outer layers, this procedure replaces that damaged tissue with donor tissue by removing the damaged endothelium through a small hole in the cornea.

Blepharoplasty

This is an operation on the eyelids. It is most often a cosmetic procedure rather than a necessary medical procedure. This improves the appearance of the upper, lower, or both pairs of eyelids by removing fat or excess tissue to lessen wrinkles, widen eyes, and reduce the appearance of bags under the eyes.

Refractive lens exchange (RLE)

This is an alternative to LASIK for older adults who are no longer good candidates for laser eye surgery. Like cataract surgery, your ophthalmologist or eye surgeon will remove the natural lens from your eye since it no longer refracts light effectively. Then, an artificial intraocular lens (IOL) will take its place.

Vision insurance might cover a monovision IOL, which gives you good middle-distance vision, but you will still need to wear glasses for close-up or distance vision. You might get a multifocal or extended vision range IOL, but these are not considered medically necessary, so your insurance may not cover it.

Prelex (presbyopic lens exchange)

This is a type of RLE specific to older adults who have presbyopia, or age-related farsightedness. The lens is replaced with a multifocal IOL rather than changing the shape of the cornea to refract light. Most patients receive 20/20 vision, and some achieve “super-vision,” or vision that is better than 20/20.

Phakic IOL

Some people have severe refractive errors that require surgery, but they are not good candidates for LASIK. The phakic intraocular lens (IOL) is sometimes called an implantable contact lens since it helps the natural lens of the eye to more effectively refract light.

Your ophthalmologist will determine whether your phakic IOL should sit in front of or behind the iris of the eye to improve refraction. While a flap will be created in the cornea, there is no corneal reshaping and your lens will not need to be removed, which supports shorter healing time.

Conductive keratoplasty

This is a noninvasive operation to improve farsightedness in middle-aged and older adults, using heat to reshape the cornea instead of lasers. Heat is applied to the outer cornea using a probe emitting controlled amounts of radiofrequency (RF) energy. The heat causes the cornea to shrink and tighten, increasing the steepness or curvature to improve distance vision.

Diabetic retinopathy surgery

Uncontrolled diabetes can damage several organs in your body, including your eyes. Diabetes can damage blood vessels all over your body, including the small vessels that feed your retina. When your retina does not receive enough oxygen, your vision can dim or you can become blind.

There are few surgical treatments for diabetic retinopathy. Your best option is to work with your physician to manage your diabetes. If blood vessels begin to rupture or grow abnormally in your eyes, photocoagulation using targeted lasers can reduce this problem to keep the retina healthier.

Macular degeneration surgery

Macular degeneration is a disease of the macula, the center of the retina, causing the loss of your central vision. “Wet” macular degeneration occurs when abnormal blood vessels form underneath and around the retina and begin to leak, damaging the macula. Injections of anti-VEGF medications can slow the growth of abnormal blood vessels, but there are few other treatments, as this degenerative disease is difficult to slow once it begins.

Intacs

This is a type of removable device that can stretch the cornea and improve nearsightedness and astigmatism caused by keratoconus, or an abnormal, conical shaped cornea. Your ophthalmologist will adjust these during treatment, like a doctor would adjust braces to align teeth, until your cornea is in a healthy position.

Strabismus surgery

It is rare that this condition requires surgery, but in some cases, changing the length of the muscles around the eyes can help them realign and improve vision. Typically, an optometrist or ophthalmologist will work with their patient to improve the strength of eye muscles with vision therapy and prescription lenses, but rare cases of strabismus do not respond to these nonsurgical treatments.

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Are Eye Surgeries Covered by Insurance?

While some eye surgeries are considered cosmetic and not covered by vision insurance, many others are necessary to prevent or reduce blindness. For example, LASIK is not often covered by vision insurance, while glaucoma treatment will be.

If your ophthalmologist or optometrist recommends surgery for a vision problem, ask about insurance coverage and how you can pay for this treatment plan.

References

1. Cataract Surgery: Risks, Recovery, Costs. (September 2021). American Academy of Ophthalmology (AAO).

2. LASIK. (March 2018). United States Food and Drug Administration (FDA).

3. What Is Glaucoma? Symptoms, Causes, Diagnosis, Treatment. (September 2021). American Academy of Ophthalmology (AAO).

4. About Corneal Transplantation. (September 2021). American Academy of Ophthalmology (AAO).

5. Eyelid Surgery: Blepharoplasty. American Society of Plastic Surgeons.

6. Refractive Lens Exchange in Modern Practice: When and When Not to Do It? (December 2014). Eye and Vision, BMC.

7. PRELEX Surgery Reduces Need for Spectacles, Surgeons Say. (February 2002). Ocular Surgery News.

8. Alternative Refractive Surgery Procedures. (September 2017). American Academy of Ophthalmology (AAO).

9. Diabetic Retinopathy. American Optometric Association (AOA).

10. Macular Degeneration. American Optometric Association (AOA).

11. Keratoconus. American Optometric Association (AOA).

12. Strabismus (Crossed Eyes). American Optometric Association (AOA).