Despite Short-term Visual Advantages, FLACS Not a Better Care Option than Phaco

The sole statistically significant discrepancy in CDVA detected between the FLACS and phaco group emerged at the one-week postoperative time point, with no further differences identified. Photo: Wikicommons/Augen33. Click image to enlarge.  Conventional phacoemulsification cataract surgery is extremely successful, but relies heavily on surgical expertise. An alternative approach, femtosecond laser-assisted cataract surgery (FLACS), which uses laser techniques to reduce ultrasound energy output, has offered an alternative approach for nearly 20 years and has its share of adherents among surgeons. Many patients, however, when presented with the option of FLACS, find the out-of-pocket expense cost prohibitive for their needs. Researchers in Taiwan conducted a meta-analysis to comprehensively evaluate FLACS vs. conventional phaco to assess efficacy, safety and patient satisfaction, with corrected- and uncorrected-distance visual acuity (CDVA, UDVA) as the primary outcomes.FLACS yielded a significantly better CDVA one-week postoperatively, but there were no significant differences in CDVA beyond that time point, or in UDVA, spherical equivalent or surgically induced astigmatism. Ultimately, the overall complications, patient-reported health, visual and daily-activity outcomes were not significantly different between the two cataract surgery options.Encompassing a total of 8,871 eyes (4,479 FLACS, 4,392 conventional), the studies used in the meta-analysis were conducted from 2011 to 2022. Geographically, Europe held the majority (58%), followed by Asia and America. The mean age of the participants ranged from 52.8 to 79.1 years. Regarding the postoperative complications, no significant differences were observed in various aspects, such as macular edema within three months and 12 months, corneal edema within three months, elevated IOP within 24 hours and posterior capsular opacification within 12 months.The intraoperative complication rate did not differ significantly between the FLACS and phaco groups, with early issues related to FLACS attributed to its learning curve.“Besides efficacy and safety, quality of life is another important issue after cataract surgery; however, to the best of our knowledge, no meta-analyses have addressed these issues,” the study authors wrote in their paper, which was published in Scientific Reports.The meta-analysis evaluated five studies that used patient-reported outcome measures from various questionnaires that asked the patients to rate their experience as excellent, good or neutral. The data was categorized into three subgroups based on the questionnaire type or question: patient-reported health outcomes, visual outcomes and daily-activity outcomes. The analysis of these three subcategories revealed an absence of significant differences between the FLACS and phaco groups.While FLACS showed preliminary advantages in reducing effective phacoemulsification time and cumulative dissipated energy, the additional time for patient docking and laser application often increased the overall operative duration, especially for experienced surgeons, the report noted. “This extended time, combined with higher instrument costs, generally makes FLACS not a cost-effective alternative to phaco for routine cases,” the researchers noted.Click here for the journal source. Lee SH, Chiu YC, Tsai PC, et al. Femtosecond laser-assisted cataract surgery vs. conventional phacoemulsification cataract surgery: a meta-analysis of randomized controlled trials. Sci Rep. 2025;15(1):27569.  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.