Cornea and External Disease
This subspecialty involves the diagnosis and management of diseases of the cornea, sclera, conjunctiva and eyelids, including corneal dystrophies, microbial infections, conjunctival and corneal tumors, inflammatory processes and anterior ocular manifestations of systemic diseases. Training in this area frequently includes corneal transplant surgery and corneal refractive surgery to correct refractive errors.
Cataract and Refractive Surgery
A relatively new subspecialty within ophthalmology, this field involves the surgical management of refractive errors in the human eye. Training in this specialty is sometimes included in corneal and external disease fellowships and uses some of the most recent technological advances within the field of ophthalmology.
This subspecialty includes the treatment of glaucoma and other disorders that may cause specific types of ophthalmic damage, usually associated with increased intraocular pressure and ultimately manifesting typical optic nerve changes. This area involves the medical and surgical care of both pediatric and adult patients, including new laser applications and implantation of drainage devices.
Uveitis and Ocular Immunology
The term “uveitis” describes inflammation of the middle layer of the eye, which consists of the iris, the ciliary body and the choroid. This subspecialty involves the medical diagnosis and management of immune-mediated conditions of the eye. A subspecialist in this field has advanced training in ocular immunomodulatory therapy and frequently works closely with rheumatology and immunology specialists.
This subspecialty involves both the medical and surgical treatment of retinal and vitreoretinal disease. The types of diseases treated include manifestations of local, systemic and genetic diseases as they affect the retina and vitreous. Diagnosis involves the use and interpretation of ultrasound, fluorescein angiography and electrophysiology. Treatment methods include laser therapy, cryotherapy, retinal detachment surgery and vitrectomy (removal of the vitreous).
Ophthalmic Plastic Surgery
The practice of ophthalmic plastic surgery includes orbital surgery, cosmetic lid surgery and lid and upper facial reconstructive procedures following trauma and tumors. Oculoplastic surgeons combine ophthalmic surgery with plastic surgery and are trained in the use of radiotherapy, chemotherapy and chemosurgery to treat ocular and orbital disease.
The bulk of pediatric ophthalmic practice involves the medical and surgical management of strabismus, amblyopia, genetic and developmental abnormalities and a wide range of inflammatory, traumatic and neoplastic conditions occurring in the first two decades of life. This subspecialty also deals with the ocular manifestations of certain systemic disorders. Pediatric ophthalmologists frequently treat adult ocular motility disorders as well.
Involving the relationship between neurologic and ophthalmic diseases, neuro-ophthalmology also deals with local pathology affecting the optic nerve and visual pathways. Over 50 percent of all intracranial lesions involve the visual or oculomotor pathways. Neuro-ophthalmology is generally practiced as a nonsurgical subspecialty but can be combined with surgery of the eye and orbit.
The ophthalmic pathologist has training in both ophthalmology and pathology, typically in that order. Because of the unique combination of skills involved in this subspecialty, it is usually the ophthalmic pathologist (rather than the general pathologist) who examines tissue specimens from the eye and adnexa.