Surgery for Cataract

Several different types of intraocular lens implants have been developed that not only replace the cloudy natural lens and restore clarity but also give you the option of improving other aspects of your vision at the same time. NYU Langone doctors can help you to determine which type of intraocular lens suits you best, based on your vision needs, your lifestyle and activities, and your budget. Some intraocular lenses are not covered by insurance.

The traditional type of intraocular lens implant is a monofocal lens. It has been used for decades by millions of people. Monofocal lenses can improve either nearsightedness, which is when a person sees close-up objects clearly but has trouble focusing on distant objects, or farsightedness, which is when distance vision is clear but close-up vision is blurry. You can then wear glasses to optimize vision at the other focal point. 

Other lenses, known as multifocal lenses, can improve your range of vision from near to far, decreasing or eliminating the need for glasses.

People with astigmatism may consider a toric intraocular lens. Astigmatism is a condition in which the cornea—the front part of the eye—is not round and smooth but irregularly curved, causing distortion or blurriness in both near and distance vision. The toric intraocular lens is a monofocal lens with astigmatism correction built into it. It does not necessarily eliminate the need for glasses after surgery.    

After you decide on the type of intraocular lens, you and your doctor can discuss which method of surgery is best for you.

Small-incision surgery, or phacoemulsification, is the most common type of cataract surgery. It is generally used to treat people who have cataracts that are small to moderate in size. 

This outpatient procedure is performed using local anesthesia and a mild sedative. The surgeon makes a small incision in the eye and inserts a probe that emits ultrasound waves to soften and break up the affected lens. The lens particles are then removed, and the new artificial lens is put in place. 

Within days, most people experience a significant improvement in vision and are able to resume normal activities within a week or two.

Large-incision surgery is an older technique that is still occasionally used when cataracts are larger and vision is more compromised. The surgeon makes an incision in the eye and removes the affected lens in one piece. Then the new artificial lens is put in place. 

Because the incision is larger, this surgery sometimes requires stitches; however, they are so small that you cannot feel them. Some types of stitches dissolve on their own as you heal from surgery. Others need to be removed after surgery. Your doctor takes these out in the office when he or she decides they should be removed, usually after a few days. You are given a topical anesthetic during the removal of the stitches to ensure you don’t feel any pain.

Large-incision surgery is also an outpatient procedure, performed using local anesthesia and a mild sedative. The healing process typically takes slightly longer after this procedure than after small-incision surgery.

In femtosecond laser surgery, a relatively new technology is used to remove cataracts. During this procedure, the surgeon uses a laser to make very precise incisions in the eye to soften or break up the cataract before removing the lens. This technique enables the surgeon to complete the procedure as precisely and safely as possible, ensuring that the intraocular lens is placed correctly, so that it can best improve your vision. If you have astigmatism, the laser can also be used to reshape the surface of your cornea in order to sharpen your overall vision.  

As with small and large-incision surgery, people who have this procedure can usually resume activities within one to two weeks of surgery.