Femto, Conventional Cataract Approaches Have Comparable Long-Term Visual Outcomes

Phaco tip being inserted into eye of patient with cataract, A phaco tip emits an ultrasonic wave that emulsifys the lens nucleus. As it breaks it down, a small hole in the tip suctions out the cataract, leaving the posterior capsule in contact. (Photo by Universal Images Group via Getty Images)
Researchers compared the technologies at 1 month, 3 months, and 1 year.

Long-term visual outcomes of femtosecond laser-assisted cataract surgery (FLACS) are comparable with those of standard phacoemulsification cataract surgery (PCS), according to research published in Clinical Ophthalmology.

The investigators compared the long-term visual outcomes of the 2 approaches.

They analyzed data from 298 eyes that underwent PCS (n=155) or FLACS (n=143) by 1 of 4 surgeons between 2018 and January 1, 2021. Surgeons performed phacoemulsification using the Infiniti Vision System. FLACS treatment was conducted with the CATALYS femtosecond laser system and the WhiteStar Signature phacoemulsification system. After surgery, all patients took fluoroquinolone antibiotic eye drops, topical steroids, and topical NSAID eye drops. 

The investigators found that mean logMAR uncorrected distance visual acuity (UDVA), best distance visual acuity (BDVA), and uncorrected near visual acuity (UNVA) were comparable between the 2 treatment groups at 1 week, 3 months, and 1 year. The patients who underwent FLACS were more likely to have UDVA of at least 20/40 compared with those who underwent PCSand have at least 20/20 UNVA at 1 week. Twenty-eight eyes that underwent PCS experienced improvement of BDVA by 2 lines, which was significantly more than the 13 eyes in the FLACS group that experienced this improvement (P =.001).

Six patients underwent limbal relaxing incision (LRI). Patient satisfaction was not statistically different between the groups (11% PCS, 10% for FLACS at 1 month, 12% for PCS and 6% for FLACS at 3 months, and 15% for PCS and 12% for FLACS at 1 year).

“The adoption of FLACS in clinical practice is based on its equivalence or superiority to the traditional PCS and the financial opportunities associated with the use of cutting-edge technology,” the researchers report. “Although the implementation of FLACS has economic benefits and marketing opportunities, clinicians should also consider the disrupted flow of the surgical process and increased procedure time. The economics of cataract surgery are highly dependent on case volume and reduction in efficiency renders the adoption of FLACS a precarious decision. Our study found the safety index (0.11 for PCS and 0.04 for FLACS) and the efficacy index (0.89 for PCS and 1.15 for FLACS) to be similar between the two groups, making it difficult to justify additional expenses for certain patient populations.”

The study shows PCS patients tend to spend a mean 4 additional minutes in the operating room compared with FLACS patients, excluding femtosecond laser time.

Limitations of the study include small sample size and variations in surgery technique, along with possible confounding bias for the FLACS group and selection bias.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Moshirfar M, Waite AJ, Ellis JH, et al. A one year longitudinal comparative analysis of visual outcomes between femtosecond laser-assisted cataract surgery and standard phacoemulsification cataract surgery. Clin Ophthalmol. 2021;15:4667-4680. doi:10.2147/OPTH.S336356