Conditions and Treatments
We want you to be well-informed as you prepare for surgery.
Anesthesia Used in Eye Surgery
The type of anesthesia that will be used during your eye surgery varies depending on the type of procedure being done and your health history. No matter the type of anesthesia you receive for your eye surgery, there is always an anesthesiologist on-site and a nurse anesthetist involved in your procedure. At Tennessee Valley Eye Center, we are committed to your both your safety and your comfort during any surgery.
The types of anesthesia generally used for eye surgery fall into several categories:
Topical Anesthesia, also known as “Eye Drop” Anesthesia involves the use of eye drops to numb the eye, allowing you to have a comfortable procedure. Patients receiving topical anesthesia will also be lightly sedated during the surgery.
Regional Anesthesia, also known as “Eye Block” Anesthesia is the administration of a local anesthetic to numb the nerves around the eye. The block eliminates all feeling and movement in the region of the eye and involves one or two quick injections near the eye after a sedative has been administered to make you sleepy for a few minutes.
General Anesthesia involves the administration of a general anesthesia agent, which affects the entire body and renders the patient unconscious during the procedure. Before receiving general anesthesia, patients must visit Tennessee Valley Eye Center for a pre-admission evaluation by our nurses and anesthesiologist.
If the lens of your eye becomes cloudy, the light reaching the retina (the back of the eye) is blurred and distorted, and your vision is affected. This clouded lens is called a cataract, and it must be removed before vision can be restored. The lens tends to cloud naturally as people age, resulting in a gradual reduction in vision. Cataracts affect almost 75% of the American population aged 65 and over.
The experienced surgeons of Tennessee Valley Eye Center perform over 7,000 cataract procedures each year.
During cataract surgery, the cloudy and hardened lens is removed through a process called phacoemulsification, which means breaking up the lens with ultrasonic vibrations. A new, artificial lens is then placed in the eye. This lens is called an intraocular lens (“IOL”). Many patients who are undergoing cataract surgery who have nearsightedness or farsightedness can have these distortions corrected by a standard cataract procedure with implementation of a standard “monofocal” IOL and achieve good distance vision without glasses.
Custom cataract surgery refers to not only removing the cataract, but also replacing the cataract with an IOL that can help reduce your dependence on glasses or bifocals. Many patients may benefit from placement of a premium IOL, which may help you not only have good distance vision, but also read a book, drive a car, play golf or tennis, all with an increased freedom from glasses. Custom cataract surgery with a premium IOL is designed to address presbyopia (age-related difficulty seeing up close) or astigmatism (uneven curvature of the cornea). Talk with your surgeon to determine whether or not a premium IOL is a good fit for you.
Tennessee Valley Eye Center physicians perform more corneal transplants than any other healthcare facility in East Tennessee.
The cornea is the transparent layer of tissue that covers the front of the eye. The cornea refracts rays of light as they enter the eye and proceed to the retina, allowing us to see clearly. After minor scratches or injuries, the cornea usually heals on its own. Deeper injuries or corneal disease can cause corneal scarring, resulting in a haze on the cornea that impairs vision. Surgeons specializing in cornea and external eye diseases:
- Perform corneal transplants, in which damaged or diseased cornea tissue is replaced with healthy tissue from a donor
- Reshape and restore the cornea with laser surgery
- Treat corneal dystrophy, in which the eye develops scarring or gradually loses endothelial cells (cells that prevent swelling of the cornea)
If you have a 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.
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.
Torn or Detached Retina
The inner eye is filled with a clear gel-like substance called vitreous. With age, the vitreous gel undergoes the natural aging process, deteriorating and becoming liquid. When the eye moves, the small pockets of liquid move around inside the vitreous cavity. This movement can cause the vitreous to pull on the retina, and the results of that pulling can lead to various issues in the eye, including:
- Posterior vitreous detachment (floaters)
- Torn retina
- Vitreous hemorrhage (blood in the eye)
- Detached retina
Detached retinas can also occur following a physical trauma. The symptoms of retinal tears and detachments include floaters, flashes, shadows or curtains over vision, and decreased vision. While some retinal tears can be treated with laser surgery, large retinal detachments must be surgically repaired. The retina surgeons affiliated with Tennessee Valley Eye Center will provide the most appropriate of the following surgical treatments to meet your needs:
- Laser retinal surgery
- Pneumatic Retinopexy
- Scleral Buckling
Diabetes interferes with the body’s ability to store or use sugar properly. High blood sugar can damage the blood vessels in the eye. The damage to retinal vessels is called diabetic retinopathy. In later stages, the disease may lead to new blood vessel growth over the retina, causing scar tissue to develop, which can pull the retina away from the back of the eye. This is known as a retinal detachment and can lead to blindness if left untreated. Diabetic Retinopathy can also lead to glaucoma if not properly treated.
If you have diabetes, it is important to have regular eye exams. If surgery becomes necessary, the retina specialists associated with Tennessee Valley Eye Center can treat diabetic retinopathy, primarily through vitrectomy.
Eyelid Disorders (Medical or Cosmetic)
The surgeons of Tennessee Valley Eye Center who specialize in treating eyelid disorders are able to address issues such as eyelid and orbital trauma, congenital abnormalities, blepharoplasty, ptosis (droopy eyelids), and cancer of the tissues around the eye. In addition, they perform cosmetic surgery for adults wishing to improve the appearance of their eyelids or brows while, in some cases, also improving vision.
Glaucoma is a progressive condition in which the internal pressure of the eye increases, causing damage to fibers in the optic nerve that can result in permanent loss of vision. Glaucoma is a leading cause of blindness and visual impairment today. People at highest risk for glaucoma are those who have a family history of glaucoma, African Americans, diabetics, and individuals who are very nearsighted or have had a previous eye injury.
Glaucoma surgeons affiliated with Tennessee Valley Eye Center perform a range of surgical procedures in the treatment of glaucoma, including:
- Minimally Invasive Glaucoma Surgery – a group of less invasive surgical procedures that offers a significant level of safety combined with mild-to-moderate pressure reduction. They work on the micro-level to help reduce the risk of complications that are more common in major forms of glaucoma surgery.
- Laser Trabeculoplasty – The surgeon uses a very focused beam of light to treat the drainage angle of the eye, which makes it easier for fluid to slow out of the front of the eye, helping to decrease the pressure inside the eye.
- Laser Peripheral Iridotomy – The surgeon uses a very focused beam of light to create a hole on the outer rim of the iris, the colored part of the eye, which allows fluid to flow between the front of the eye and the part of the eye behind the iris, helping to decrease pressure in the eye.
- Trabeculectomy – A surgical procedure in which a piece of tissue in the drainage angle of the eye is removed, creating an opening. The opening is partially covered with a flap of tissue. This new opening allows fluid to drain out of the eye, helping to decrease pressure in the eye.
- Aqueous Tube Shunt – In this surgical procedure, a small, flexible tube is inserted into your eye through an opening made in the wall of the eye. This tube then acts as a drain to shunt the eye’s fluid to one or two reservoirs, for the purpose of decreasing the pressure in the eye.
- Express Mini Shunt – A stainless steel shunt is implanted under the scleral flap through a small opening, allowing the surgeon to avoid cutting the interior of the sclera (white part of the eye) or the iris (colored part of the eye).
The purpose of all surgical interventions for glaucoma is to reduce the internal pressure of the eye and reduce the risk of nerve damage and loss of vision.
Macular degeneration is a deterioration or breakdown of the macula, a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. When the macula does not function properly, your central vision can be affected by blurriness, dark areas, or distortion. While macular degeneration is frequently treated through medical means, if your physician recommends surgery, the retina specialists affiliated with Tennessee Valley Eye Center can help you through the use of laser surgery.
Muscular Disorders of the Eye
Most muscular disorders of the eye are classified as strabismus, or a misalignment of the eyes, which causes the eyes to point in different directions. Most adults with strabismus have had issues since childhood. There are, however, some diseases that can cause an adult to develop a new case of strabismus, such as diabetes, thyroid disease, brain tumor, stroke, or head trauma. While some muscle diseases can be treated with non-surgical methods, if surgery is required, the specialists affiliated with Tennessee Valley Eye Center can help.
Eye muscle surgery consists of weakening or strengthening one or more muscles in one or both eyes, depending on the type of strabismus. This procedure is done under general anesthesia.
Vitreo-retinal surgery is any surgery performed to treat disorders of the retina (the light-sensing cells at the back of the eye) and vitreous (the clear gel-like substance inside the eye). The experienced retina specialists associated with Tennessee Valley Eye Center perform more retina surgery than any other organization in East Tennessee. The primary types of vitreo-retinal surgery performed at Tennessee Valley Eye Center are:
Vitrectomy may be used to treat a severe eye injury, diabetic retinopathy, retinal detachments, macular pucker (wrinkling of the retina), and holes in the macula.
During a vitrectomy, the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous and repairs the retina through these tiny incisions.
During the procedure, the retina may be treated with a laser to reduce future bleeding or to fix a tear in the retina. An air or gas bubble that slowly disappears on its own may be placed in the eye to help the retina remain in its proper position, or a special fluid that is later removed may be injected into the vitreous cavity.
Recovering from vitrectomy surgery may be uncomfortable, but the procedure often improves or stabilizes vision. Once the blood- or debris-clouded vitreous is removed and replaced with a clear medium (often a saltwater solution), light rays can once again focus on the retina. Vision after surgery depends on how damaged the retina was before surgery.
Laser Retinal Surgery
The precision and predictability of laser energy makes it an ideal tool for eye surgery. Laser surgery is used to treat a range of retinal disorders, including:
- Diabetic retinopathy
- Retinal blood vessel problems
Pneumatic Retinopexy is an effective surgery for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina.
Scleral buckling surgery is a method of repairing a detached retina by using a sponge or piece of silicon that is placed outside of the eye and sewn in place in order to push the sclera toward the retina. This method closes breaks and flattens the retina.