Features of Femto Laser-Assisted Cataract Surgery (FLACS)
How Is Femto Laser-Assisted Cataract Surgery (FLACS) Performed?
Clear Corneal Incision
In order to get to the cataract a surgeon needs to create an incision (cut) through the cornea. This is generally done with a very small, sharp metal or gem blade. These incisions are often self-sealing. The Femto laser can also make incisions in the cornea. However, there does not appear to be any real advantage to making these incisions with a laser. Indeed, many surgeons feel that use of a metal or gem blade allows them to better position the incision.
Creation of Capsulotomy
Creating an opening in the bag that holds the lens inside the eye is called “capsulorrhexis” (or “capsulotomy”). It is also one of the more technically difficult steps in cataract surgery. Many surgeons would appreciate having this step automated.
In addition, one of the major challenges in modern cataract surgery is “hitting the refractive target.” In other words, improving the surgeon’s ability to choose the correct IOL. In theory, a perfectly round, centered and sized capsulorrhexis could decrease some of the variability that currently limits a surgeon’s ability to “hit the target.” Although many ads have touted this as a benefit of Femto Laser-Assisted Cataract Surgery, such improved accuracy has yet to be proven.
Softening of Cataract
The energy used to emulsify the cataract with ultrasound can damage the cornea. Therefore, if the cataract could be made softer by cutting it into pieces with a laser prior to ultrasound then (at least in theory) there may be less damage to the eye during cataract surgery.
Alas, laser energy is also absorbed by the cornea. The cornea doesn’t seem to care whether it’s laser energy or ultrasound energy – it doesn’t like either one. So to state that laser cataract surgery results in less energy in the eye is a bit like telling someone they will save money if they pay for something in Euros instead of dollars. If the price of something is the same, does it matter what currency is used?
Correction of Astigmatism
Astigmatism is one of the reasons people need to use spectacles to see well. If the cornea is shaped more like a football than a basketball then astigmatism is present. The Femto laser can be used to place “relaxing incisions” in the cornea to address astigmatism at the time of cataract surgery. In theory these would be more predictable than incisions made with a metal or diamond blade. In practice, however, this has not been demonstrated.
Indeed, there are far more reliable and accurate methods of addressing astigmatism during or after cataract surgery. One such method involves placing an astigmatism-correcting intraocular lens (IOL) in the eye at the time of cataract surgery. The other is use of laser corneal refractive surgery (such as LASIK). Both of these proven methods of correcting astigmatism can be done without the use of a Femto laser.
A Note about the Touted Features of Femto Laser-Assisted Cataract Surgery (FLACS)
In marketing, there is a distinction made between product “features” and “benefits”. Features are things like “made with genuine Samurai steel”. They can sound impressive, but how does that benefit you, the consumer (or patient)? Benefits would include things such as “makes carving your Thanksgiving turkey a pleasure” or “allows you to see the ticks on the wool of a sheep grazing on the peak of a mountain range two miles away” (actual statement of a patient of mine after I had performed cataract surgery without use of a laser – I think, BTW, that he may have been exaggerating just a bit as I had trouble seeing the ticks myself and I don’t have cataracts yet).
So does laser-assisted cataract surgery provide any real benefit to you, the patient? Or, is it nothing more than a feature-rich technology that sounds really neat but ultimately doesn’t provide anything of real value?
Let’s take a look together…