There are different types of surgery; emergency, semi-elective, elective and cosmetic. The differences lie between the timing (immediate), loss of life or function…or cost. Emergency surgery must be completed immediately to avoid death, loss of a limb or organ providing a specific function.
Emergency Eye Surgery
There are two situations where retina surgery is an emergency; intraocular infection (endophthalmitis) and a retinal detachment where the macula is attached, but the retina immediately above the macula is detached.
Intraocular infection can permanently blind within hours. A retinal detachment above the macula may spread below and detach the macula, potentially causing permanent loss of (some) vision. If the macula is re-attached successfully, there is no guarantee full vision will return. Thus, we try to operate before the macula detaches.
Semi-Elective Retina Surgery
Repair of an old retinal detachment, removal of ERM, closure of a macular hole are examples of semi-elective surgery. In my opinion, the visual prognosis worsens the longer you wait. In other words, the longer you wait to have surgery, even if performed successfully, the worse your resultant vision may be.
Cataract Surgery is Elective Eye Surgery
Cataract surgery and removal of floaters are great examples of “elective” surgery. Elective means the timing of the surgery is up to the patient and is optional. The timing has no effect on the outcome or results. In both situations, there is loss of function, that is, patients can not see.
Elective procedures, however, can be covered by insurance. Elective simply means the timing of the surgery doesn’t matter. Insurance usually provides coverage for health problems which can be corrected. In this example, vision is restored.
Elective Surgery is Covered
Cosmetic surgery and elective surgery are both time independent, both are optional, but cosmetic does not involve loss of function.
There is no retinal cosmetic surgery example, but other examples of purely cosmetic surgery include facelifts, breast augmentation, liposuction, etc.
Cosmetic surgery, or aesthetic surgery, does not deal with conditions related to loss of function. It is elective and in most cases, not covered by insurance.
What Does This Mean?
I wrote this due to the many questions I receive about insurance coverage. Emergency and Semi-Elective surgery seem pretty intuitive, but I found the differences between elective and cosmetic surgery were less clear.
If you classify surgery by the function intended to cure, you’ll have a much easier time understanding the utility, purpose and insurance ramifications.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
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