Ophthalmology is a surgical specialty that deals with the eye and the physiological systems that make eyes function. An ophthalmologist - not to be confused with optometrist - is a medical doctor (M.D.) or doctor of osteopathy (D.O.) who provides medical care and performs surgery to treat eye disease and injury and correct vision problems.

Ophthalmic surgery procedures at Mission include but are not limited to:

• Cataract extraction. A cataract is most often a process of aging that clouds the natural focusing lens of the eye and impairs vision. In cataract surgery, the clouded lens is removed and replaced by an intraocular (IOL) lens, also called an implant. Performed under a microscope, the procedure involves a small incision that allows the cloudy tissue to be removed and the IOL to be put into place. This is the most frequently performed surgery in the United States and is almost always an outpatient procedure under local or topical anesthesia. Nationally, more than 90 percent of the patients who have cataract surgery regain useful vision. Patients almost always see improved vision within four to six weeks, many times in as few as one to two weeks.

• Cornea transplantation. The cornea is the transparent coating that covers the iris and pupil and helps focus light inside the eye. When a cornea becomes diseased or injured enough to impair vision, it can be replaced with a donor cornea from a tissue donation bank. The donor cornea is sewn into place during a procedure, which is usually performed under general anesthesia. Recovery time for vision ranges from a few months to a year.

• Glaucoma surgery (trabeculectomy). With glaucoma disease, normal drainage of fluid within the eyeball is impaired, increasing pressure within the eye to abnormal levels. The optic nerve that carries visual stimuli to the brain can be damaged by this added pressure, causing irreversible vision loss. Trabeculectomy involves a small incision in the eye and the creation of a small tissue flap over the incision. This outpatient procedure allows a slow release of fluid to the outer eye layers, restoring normal pressure within the eye and preventing further damage to the optic nerve.

• Oculoplastic surgery (reconstructive). This area of ophthalmic surgery encompasses a wide range of procedures to improve the appearance and function of eyelids and related structure. Some are done with a laser instead of an incision. In general, oculoplastic surgeons can:

• reconstruct drooping, loose or baggy eyelids

• treat patients with tear duct blockages

• repair injured eyelids

• Retinal surgery. The retina is the nerve layer at the back of the eye that senses light and sends visual stimuli to the brain. Disease or injury can cause the retina to tear, often leading to its detachment from the back of the eye. If a detached retina is not repaired, the eye will continue to lose sight and eventually become blind--its detachment causes the retinal nerve cells to be separated from nutrients and die. A retinal tear or detached retina should receive immediate treatment to prevent irreversible vision loss. Retinal surgery can include:

• Repair of retinal tears. A laser is used to physiologically weld the torn area back into place, which can prevent retinal detachment. Cryo-surgery (freezing) techniques can also be used to fuse tissue, but laser procedures tend to be more comfortable and result in less retinal scarring.

• Repair of leaking and abnormal blood vessels. Laser treatment is used to seal leaking blood vessels to prevent or reverse swelling that causes blurred vision and retinal scarring. Ophthalmologists also use lasers to treat abnormal blood vessel growth in the retina, a condition caused by diabetes and a leading cause of blindness.

• Repair of a detached retina. There are several ways to repair a detached retina. Vitrectomy removes vitreous gel within the eye that is pulling on the retina. Pneumatic retinopexy injects a gas bubble into the eye to push the retina back into place. A schleral buckle is a flexible band put into place around the eye to counteract what is pulling the retina out of place. Back in position, the retina is reattached using laser or cryo-surgery techniques.

Many ophthalmic surgical procedures are performed on an outpatient basis at Mission's Asheville Surgery Center, a state-of-the-art ambulatory surgery facility opened in May 2000.

Refractive vision correction surgeries such as photo refractive keratectomy, laser-assisted in-situ keratomileusis (LASIK) and radial keratotomy are performed independently of Mission in the offices of ophthalmologists.