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01/09/2021
Cataracts are a leading cause of reversible vision loss, especially in people over 60 years of age. As such, cataract surgery (the process of removing the cloudy lens of the eye and replacing it with an artificial one) is one of the most commonly performed operations in the world.
There are two types of cataract surgery, which are both highly successful and generally safe procedures. They include traditional cataract surgery (also known as manual or conventional cataract surgery) and femtosecond laser-assisted cataract surgery (or FLACS for short).
Traditional cataract surgery involves the ophthalmic surgeon manually completing all steps of the procedure. However, femtosecond lasers were introduced in 2010 to help the surgeon perform some of these steps.
The patient’s view during laser cataract surgery.
The first part of the operation is carried out in a dedicated laser suite. Lying down, the patient looks at a light, which aligns their eye with the laser. The machine takes detailed images of the cornea (the eye’s clear outer surface) and the cataract. It measures the exact position of the anterior capsule, which is the membrane that covers the front of the eye’s natural lens.
From these images, the laser can cut a perfectly circular opening into the capsule (known as a capsulotomy).
The capsulotomy is considered one of the most challenging steps of a manual cataract operation.2 The pre-programmed laser then cuts into the affected lens using a specific pattern to break up the structure of the cataract.
The remainder of the procedure takes place in an operating theatre, where the surgeon removes the pre-cut disc on the front side of the capsule and uses ultrasound energy to break up the affected lens into small pieces (a process called phacoemulsification). Less ultrasound energy is required to complete phacoemulsification because the cataract has already been pre-cut by the laser.
A small vacuum is used to remove these pieces. At the end of the procedure, a new artificial replacement lens (called an intraocular lens or IOL) is placed inside the eye.
Patients undergoing FLACS laser cataract surgery usually remain in the dedicated laser room for just under 6 minutes – the actual ‘laser’ part of the operation takes less than a minute. However, a typical procedure, including the steps in the operating theatre, takes less than 30 minutes.
Allowing for admission, preparation and recovery time, patients usually stay in the day surgery for around 3 hours.
It was thought that the introduction of FLACS would make cataract surgery safer and more accurate, leading to better visual outcomes. Now that a decade has passed, a group of ophthalmologists (including Vision Eye Institute’s Dr Lewis Levitz and Dr Joe Reich AM) have taken the opportunity to look at the research available and see if FLACS offers any benefits over traditional cataract surgery.
Their peer-reviewed research paper, ‘The Latest Evidence with Regards to femtosecond Laser-Assisted Cataract Surgery and Its Use Post 2020’, was recently published in the journal Clinical Ophthalmology.
Following their review of the available data on cataract surgery using femtosecond lasers, Vision Eye Institute surgeons found that FLACS is safer than traditional cataract surgery. Since FLACS uses a pre-programmed laser, the procedure is highly accurate and less likely to damage the surrounding structures of the eye.
As a result, the risk of complications such as posterior capsular rupture (PCR), where the back of the capsule breaks during the operation, is much lower.
Capsular complications may be associated with eye infections as well as retinal (the light-sensitive tissue at the back of the eye) detachment, which requires follow-up surgery.
In addition, FLACS generates reproducible and perfectly round capsulotomies. This makes it a lot easier to precisely place the artificial lens inside the eye, limiting any tilt which could lead to poor vision.
Evidence collected over the last decade suggests that there is no long-term visual advantage in using FLACS over traditional cataract surgery when using monofocal and non-toric IOLs. Monofocal IOLs are replacement lenses that allow for clear vision at a single distance, whereas non-toric IOLs are replacement lenses that do not correct astigmatism.
However, FLACS may be important for patients who choose premium lenses (e.g. multifocal lenses, extended depth of focus lenses and toric lenses).
The placement of these types of IOLs must be as precise as possible, as any shift in the lens can cause a reduction in image quality. Seeing as FLACS produces a perfectly circular capsulotomy and has a low rate of complications, a surgeon may opt to use the femtosecond laser over traditional cataract surgery when inserting these types of IOLs in the eye.3
Typically, your sight begins to recover within a few days after surgery. However, it is normal for your vision to fluctuate for a month before it steadies. The recovery time for laser cataract surgery is the same as traditional cataract surgery.
Compared to traditional cataract surgery, FLACS is more expensive.
This is due to the high cost of this state-of-the-art technology, as well as the added expertise required to perform laser-assisted cataract surgery.
However, at-risk patients are less likely to experience PCR with FLACS (and therefore any follow-up surgeries and their associated cost).
Laser cataract surgery cost is difficult to accurately determine online due to the large selection of artificial replacement lenses. Your ophthalmologist will be able to provide you with the full cost of cataract surgery and advise whether femtosecond laser surgery is recommended, as it is not suitable for everyone. During this consultation, your ophthalmologist will perform a thorough assessment of your eyes and discuss the various replacement lens options.
While both traditional cataract surgery and laser cataract surgery are safe and effective operations, research to date confirms that FLACS offers a superior safety profile in some circumstances.
This should be considered on an individual basis when deciding between laser cataract surgery and traditional cataract surgery, particularly for patients at risk of PCR. In addition, it is important to acknowledge that the outcome of laser cataract surgery also depends on the surgeon’s skill and experience. Furthermore, opting for a premium lens may influence whether a patient chooses between FLACS or manual cataract surgery, as FLACS can help reduce IOL shift during insertion.
It is important to have an in-depth discussion with your surgeon about your eye health, vision goals, lens selection, benefits versus risks and cost when choosing between FLACS and conventional cataract surgery.
Vision Eye Institute has a number of ophthalmologists who are highly experienced in cataract surgery, including laser cataract surgery, and intraocular lenses.
Click here for a list of our cataract clinics
The information on this page is general in nature. All medical and surgical procedures have potential benefits and risks. Consult your ophthalmologist for specific medical advice.
Date last reviewed: 2024-01-18 | Date for next review: 2026-01-18
