Femtosecond Laser-Assisted Cataract Surgery (FLACS)

What Is Femtosecond Laser-Assisted Cataract Surgery?

Femtosecond laser-assisted cataract surgery is an advanced surgical technique in which certain stages of the cataract procedure are performed using computer-controlled laser technology. This technology enables intraocular incisions, capsule opening, and fragmentation of the clouded lens to be carried out with micron-level precision.

A cataract is the gradual clouding of the eye's natural lens, which leads to progressively reduced vision, increased light sensitivity, and difficulty seeing at night. Femtosecond laser technology offers a more controlled and predictable surgical process compared to the conventional approach.

How Does Femtosecond Laser Technology Work?

A "femtosecond" is one quadrillionth of a second — an extraordinarily brief unit of time. These ultra-short laser pulses mean that:

• Surrounding tissues are protected
  
• Thermal damage is minimal
  
• Incisions are exceptionally symmetric
  
• Surgical control is enhanced
  

This technology delivers a near-perfect circular opening during capsulorrhexis (the opening of the lens capsule) — a step that directly affects how well the intraocular lens centres after implantation.

Femtosecond Laser vs. Conventional Cataract Surgery

In conventional cataract surgery, intraocular incisions and lens capsule opening are performed manually by the surgeon. This approach has a long, well-established safety record and consistently delivers good outcomes. Some stages of the procedure, however, depend directly on the surgeon's manual skill and experience.

In femtosecond laser-assisted cataract surgery, these critical steps are performed by a computer-controlled laser system. Corneal incisions and the capsule opening are created with micron-level accuracy, making the surgical process more standardised and predictable.

There is also a difference in energy use between the two methods. Conventional surgery may require more ultrasound energy to break up the lens, whereas the femtosecond laser pre-fragments the lens beforehand, allowing for lower energy delivery overall — which may contribute to better preservation of corneal tissue.

Lens centration is a particularly important consideration. In conventional surgery, the shape and symmetry of the capsule opening depend on the surgeon's technique. The femtosecond laser creates a more uniform, circular capsule opening, increasing the likelihood that the implanted IOL will remain precisely centred.

Recovery is generally swift with both methods; however, in femtosecond laser procedures, reduced tissue trauma may allow some patients to experience earlier visual clarity.

The precision of the capsule opening is especially critical when premium IOLs — such as trifocal or multifocal lenses — are planned. For patients choosing a premium IOL, femtosecond laser technology can provide more predictable and stable visual outcomes.

How Is Femtosecond Laser Cataract Surgery Performed?

Femtosecond laser cataract surgery is cataract surgery enhanced by advanced technology. Certain critical steps are performed by a computer-controlled laser system, with the goal of making the procedure more precise, more controlled, and more predictable.

The operation typically takes 10–15 minutes, and you are discharged on the same day.

Pre-Operative Assessment

A comprehensive eye examination is performed before surgery. This assessment includes:

• Grading the severity of the cataract
  
• Analysing corneal structure
  
• Calculating the appropriate IOL power
  
• Evaluating the retina
  
• Checking for astigmatism
  

These measurements are essential for accurately planning the IOL to be implanted — whether monofocal, trifocal, multifocal, or toric.

The Laser Phase

The femtosecond laser device is used in the first part of the procedure.

During this phase:

• Corneal incisions are created under computer control
  
• The lens capsule (capsulorrhexis) is opened symmetrically and circularly
  
• The clouded lens is divided into small fragments by the laser
  

Because the laser operates in extraordinarily brief time intervals, it causes minimal damage to surrounding tissues while delivering high precision.

Removal of the Clouded Lens

The laser-fragmented clouded lens is removed from the eye using low-level ultrasound energy. Because the laser has already softened and pre-fragmented the lens, less energy is required — which may help protect the corneal cells.

IOL Implantation

Once the clouded lens is removed, an artificial IOL is implanted in its place. The lens is selected based on each patient's individual needs:

• Monofocal lens
  
• Multifocal (premium) lens
  
• Trifocal lens
  
• Toric lens (for astigmatism)
  

The precise, uniform capsule opening created by the femtosecond laser supports more stable and better-centred lens positioning.

Post-Operative Process

The procedure is suture-free.

You are typically discharged on the same day.

Mild blurring during the first 24 hours is normal.

Vision clears noticeably within a few days.

Regular use of prescribed eye drops and attending follow-up appointments are important parts of a smooth recovery.

What Are the Advantages of Femtosecond Laser Technology?

Femtosecond laser-assisted cataract surgery is an advanced technique that enhances surgical control compared to the conventional approach and can deliver more predictable outcomes — particularly in premium IOL procedures. The computer-controlled system allows the most critical surgical steps to be performed with micron-level precision.

Below you will find a detailed overview of the key advantages of femtosecond laser technology:

Greater Precision

The femtosecond laser fires pulses lasting one quadrillionth of a second, making it an ultra-precise system. As a result:

• Corneal incisions are created with exceptional regularity
  
• The lens capsule (capsulorrhexis) is opened in a perfectly circular and symmetric manner
  
• IOL centration becomes more stable
  

In trifocal and multifocal premium IOL procedures in particular, the quality of the capsule opening can directly affect visual performance. This precision therefore represents a meaningful advantage for post-operative outcomes.

Reduced Energy Use

In conventional surgery, the clouded lens is broken up using ultrasound energy. The femtosecond laser, by contrast, divides the lens into fragments at the start of the procedure.

This can mean:

• Lower ultrasound energy use
  
• Better preservation of corneal endothelial cells
  
• Less tissue trauma
  

This is a particularly important advantage for patients with corneal sensitivity.

Faster Visual Recovery

Lower energy use combined with a more controlled surgical process may contribute to faster post-operative visual clarity in some patients.

While recovery varies from patient to patient, femtosecond laser procedures may be associated with:

• Less oedema
  
• More stable lens position
  
• Earlier visual recovery
  

Astigmatism Correction

The femtosecond laser system can plan precise corneal incisions during surgery aimed at reducing astigmatism.

As a result:

• The need for additional surgery may be reduced
  
• Toric IOL procedures can be planned with greater accuracy
  
• Post-operative spectacle dependence may be reduced
  

For patients with astigmatism, this technology can offer a significant advantage.

Reduced Risk of Complications

The computer-assisted laser system enhances surgical control, helping the procedure progress in a more planned and standardised manner. Creating the capsule opening symmetrically and under precise control can contribute to reducing certain surgical risks.

Additionally, through lower energy use:

• Corneal cell loss may be minimised
  
• The risk of post-operative oedema may be reduced
  
• Visual stability may be achieved more quickly