A specialized technique developed specifically for ophthalmic surgery has led surgeons at the Manhattan Eye, Ear and Throat Hospital to perform most private cataract extractions-more than 1,000 per year-with patients under general anesthsia. Because this practice is followed by so few ophthalmic surgeons elsewhere, an evaluation of the relative safety and benefits of local vs. general anesthesia was undertaken. A retrospective study comparing 2,217 consecutive patients operated on under general anesthesia with 561 patients operated on under local analgesia leads us to believe that general anesthesia providess the surgeon with optimum operating conditions. General anaessthesia has proved to be a safe procedure, with a minimum of complications. The ophthalmic surgeon is assured of absolute patient immobility, with safety equilvalent to that seen with procedures performed with local analgesia, despite the advanced age and resulting physiological degeneration of the patient population.