1153: is femto laser phaco better?

Despite more than a decade of use and hundreds of published papers, there is still some controversy as to the potential advantages and disadvantages of using a femtosecond laser to assist in parts of cataract surgery. This paper is important because it is a prospective, randomized, single-center trial with experienced surgeons and patients who did not have to pay for any aspect of the cataract operation. The authors found no differences in the vision, refractive outcomes, adverse events or even patient reported measures whether or not the femtosecond laser was used. The only difference in the group was in regards to astigmatic relaxing incisions, however the mean corneal astigmatism was 1.4 diopters and a toric IOL would have likely performed much better in this setting. For most experienced surgeons there is no benefit to using the femtosecond laser, however for those who find it challenging to create a capsulorhexis or chop the nucleus, the laser can produce more consistent results in their hands. 

click for my insights regarding femto laser cataract surgery and what I would want for my own eyes:


  1. I think you are missing the point about astigmatism correction and the thresholds most of us use for Toric lenses versus LRI.
    There are also documented advantages in Fuchs dystrophy and patients with white cataracts.
    I respect your opinion, just recognize that there is a counterpoint. In the US, FLACS is mostly done for the correction of astigmatism and it would not be looked upon favorably by regulators to do it only for “safety”.
    With all due respect, I think your conclusions may be too broad.

    1. Thank you for your valuable input. Certainly in some cases like intumescent white cataracts there can be advantages. I have previously shown a video of that here on CataractCoach. Just search for femto. Our center owns two of these lasers, so certainly we have voted with our wallets in that regard. Beauty of this forum is the varied input from trusted colleagues like you. Also keep in mind that many CataractCoach readers do not have access to this very expensive technology, particularly in countries outside the USA.

  2. Technically speaking, the study mentioned here in the video cannot claim that there are no differences between the two groups in regard to the parameters being tested (p-value > 0.05). It would be more accurate to state that the study cannot find differences in these parameters. Saying there are no differences is not the same as saying we cannot find differences.

    One last thing, we actually operate with our minds. Machines and hands are secondary.

    Just some food for thought.

  3. Pediatrics
    Optic Capture in case of a posterior rupture
    Informations about the posterior capsule (Polar cataracts)
    Mini Capsulotomy in white lenses with pressure
    Posterior Capsulotomies
    Fully automated T-IOL marks

    and many more

    It is a surgical Tool with many options and even more advantages.

    Best Tim

    1. Great points. I agree. We have featured many of these points in the past here on CataractCoach. But for 97-99% of your cases which are relatively routine, is there a true benefit worth $500k?

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