Cataract Treatment and Intraocular Lenses

Cataract surgery is one of the safest and most effective procedures performed today. According to the American Society of Cataract and Refractive Surgery (ASCRS), three million Americans undergo cataract surgery each year, with an overall success rate of 98 percent or higher. With more than 11,500 cataract surgeries performed each year at New York Eye and Ear Infirmary of Mount Sinai (NYEE), our surgeons and medical support staff are among the most experienced in the field. We offer the latest surgical and lens technology to our patients to restore their vision.     

Intraocular lenses (IOLs) underscore how much cataract surgery has changed over the years. It used to be acceptable for patients to continue to use glasses or contacts following their cataract procedures. Today, surgeons at NYEE are trying to bring patients as close to 20/20 vision as possible without glasses—or at least with limited need for them—through the use of IOLs. NYEE’s highly skilled cataract specialists will discuss with you the type of treatment and intraocular lens that can deliver the best results.

How is a Cataract Removed?

There are several procedures for surgically removing the cloudy lens and replacing it with a clear, artificial lens. Cataract removal is typically done as an outpatient procedure, and most people recover quickly.

The most common method of cataract surgery is a small incision approach (2.2mm-3.0mm) known as phacoemulsification (or just “phaco”). During this procedure, the surgeon uses a computerized hand piece with a titanium or steel tip that delivers ultrasonic energy to break up the cataract into tiny fragments that are suctioned out through the instrument’s hollow tubing. These incisions are made in the clear cornea and are generally bloodless and sutureless.

Always on the leading-edge of innovation, NYEE is the first hospital in the Northeast to introduce miLOOP to its surgical tool box to treat cataracts. A pen-like micro-interventional cataract fragmentation device for high-precision, non-thermal, minimally invasive cataract surgery, miLOOP has greatly enhanced the conventional phaco surgical technique. It is especially useful in cases where patients have large and dense cataracts.

Femtosecond laser-assisted cataract surgery (FLACS) —now widely used at NYEE—embodies the latest technology for ensuring accurate, precise, and safe removal of cataracts. The computer-guided laser assists the surgeon in the performance and consolidation of many of the steps involved in cataract extraction. Prior to surgery, the laser images your eye and makes precise 3D maps of relevant structures. This enables your surgeon to create a treatment plan that is uniquely tailored to your eye. The laser creates precise incisions, including ones to treat astigmatism, if necessary, and a circular opening in the lens capsule to access and remove the cataract.  It also pretreats and softens the lens to allow a more gentle removal of the cataract. Many of the steps of cataract surgery that are traditionally performed using handheld instruments can now be completed with FLACS.

Occasionally your surgeon may need to perform an older cataract surgery technique called extracapsular cataract extraction. In this procedure, the surgeon makes a larger incision (8.5-10.5mm) through the cornea limbus to remove the lens in one piece, leaving the back part of the capsule intact to allow for implantation of an intraocular lens (IOL). After the cataract has been removed, the incision is closed with sutures.

Why is Laser Treatment Sometimes Needed Following Cataract Surgery?

There is a risk of developing posterior lens capsule opacification (PCO) following your cataract surgery. PCO occurs when the back of the lens capsule (which holds the artificial lens in place) thickens and becomes opaque, causing cloudy vision. This may require a laser treatment known as a YAG capsulotomy. This procedure uses a laser beam to create a small opening in the capsule through which light can pass to make your vision clear again.

What is an Intraocular Lens and How Does It Help my Vision?

An IOL is a permanent replacement for your natural lens. It is made of plastic, acrylic, or silicone and is implanted in the empty capsule of your eye during cataract surgery. It functions the same way your natural lens did, focusing light on the retina at the back of the eye. The IOL requires no care and becomes a permanent part of your eye; you will be unaware of its presence. Nearly all cataract patients today choose an IOL as part of their procedure, and most modern IOLs will block ultraviolet light like a good pair of sunglasses. 

Is There a One-Size-Fits-All IOL?

No. There are different types of IOLs, depending on your visual needs and lifestyle. One type of lens is monofocal, which is designed to correct vision at one focal length, far or near. Another type is multifocal, which has different focusing strengths, like bifocal or progressive glasses. Multifocal lenses allow for both near and far vision. A third type is a toric lens, which corrects for astigmatism, an irregularity in the curvature of the cornea. Also available are multifocal toric, lenses which correct for near and far distances and astigmatism. Your cataract surgeon will help you determine which type of IOL meets your visual and lifestyle needs.

To help customize your vision even further during cataract surgery, NYEE uses optiwave refractive analysis (ORA™). This state-of-the-art measuring tool allows our surgeons to confirm and make real time adjustments during the actual cataract procedure, if necessary, to ensure the proper power lens is implanted in your eye. This confirmational software provides the best outcome for you.