Cataract Surgery Options

Cataract surgery is one of the safest and most effective procedures performed today. According to the American Society of Cataract and Refractive Surgery, more than three million Americans undergo cataract surgery each year, with an overall success rate of 98 percent or higher. Tens of thousands of cataract surgeries performed each year at New York Eye and Ear Infirmary of Mount Sinai (NYEE), and 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.     

When the cloudy, cataractous lens is removed, it is replaced by an artificial lens—an intraocular lens implant (IOL). There are many different types of IOLs to suit each patient’s needs.  For example, it used to be acceptable for patients to continue to use glasses or contacts following their cataract procedures. Today, surgeons at NYEE are able 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 advanced IOLs. NYEE’s highly skilled cataract specialists will discuss with you the type of treatment and intraocular lens that can deliver the best results that fit your lifestyle.

How is a Cataract Removed?

There are several procedures for cataract removal. No matter what surgical option is used, the objective of the surgery is to remove the cloudy lens in the eye and replace it with a clear, artificial lens. Cataract removal is typically done as an outpatient procedure, and most people recover quickly.

Types of Cataract Surgery

The type of surgical procedure used to remove cataracts will depend on many factors, including your eye health, the thickness of the cataract, and finances. While insurance companies provide coverage for cataract surgery, laser-assisted cataract surgery and premium intraocular lenses (IOLs) will require you to cover out of pocket costs. During your consultation with your surgeon, you will discuss pros and cons of surgical options and IOLs available to you. 

Standard Cataract Surgery

The most common method of cataract surgery is a small incision approach (2.2 -3.0 mm) 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.

miLOOP Assisted

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

Large Incision Cataract Surgery/Extracapsular Cataract Extraction (ECCE)

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 -10.5 mm) through the cornea limbus to remove the lens in one piece, leaving the back part of the capsule intact to allow for the implantation of an intraocular lens (IOL). After the cataract has been removed, the incision is closed with sutures.

Laser-Assisted Cataract Surgery

Femtosecond laser-assisted cataract surgery (FLACS) —widely used at NYEE—embodies the latest technology for ensuring accurate, precise, and safe removal of cataracts with concurrent treatment of astigmatism. 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 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.

Patients with abnormal curvature of the front surface of the eye (cornea) or the lens inside the eye, which results in blurry vision (or astigmatism), will benefit from FLACS and its custom surgical treatment tailored to your unique anatomy of the eye.

For added precision during cataract surgery and lens implantation, we use optiwave refractive analysis (ORA™) to verify the proper intraocular lens implant power during cataract surgery. This additional step leads to an optimal outcome, as your surgeon is able to verify mid-surgery that the IOL is properly placed, thereby greatly increasing your likelihood of cataract surgery success and reducing your dependence on glasses and contact lenses.

Why is Laser Treatment Sometimes Needed Following Cataract Surgery?

There is a risk of developing posterior lens capsule opacification (PCO) following your cataract surgery, which is a result of proliferation of lens capsule cells resulting in scar tissue formation. When this occurs, it results in 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.