Femtosecond Laser-Assisted Cataract Surgery (FLACS) is an advancement used to remove a clouded natural lens. The laser performs several steps with high precision, including creating corneal incisions, the circular opening in the lens capsule (capsulotomy), and softening the cataract. While FLACS aims to increase accuracy and consistency compared to manual techniques, patients must understand the disadvantages associated with its adoption. These drawbacks relate to financial burden, specific laser-induced complications, and anatomical limitations that may prevent its use.
Higher Financial Investment
The most immediate disadvantage of laser cataract surgery is the significantly higher out-of-pocket expense compared to the conventional method, phacoemulsification. The upfront cost is driven by the multimillion-dollar price of the femtosecond laser unit and the recurring expense of disposable patient interface kits required for each operation. These specialized kits contribute substantially to the procedure’s overall fee.
Coverage for this advanced procedure is often limited because insurance providers, including Medicare, only cover the part of the surgery considered medically necessary. The laser’s use for tasks like creating the capsulotomy or treating mild astigmatism is frequently classified as an elective enhancement. Consequently, the patient is responsible for the added laser fee, which can range from hundreds to thousands of dollars per eye. This financial gap means the perceived benefits of the laser are not universally accessible, creating an economic barrier for many patients seeking treatment.
Specific Surgical Risks and Complications
While the laser is designed for precision, its use introduces distinct intraoperative complications not associated with traditional manual surgery. A necessary step is “docking,” which involves applying a suction ring to stabilize the eye and ensure accurate laser delivery. This process can temporarily raise the intraocular pressure to high levels, which is a particular concern for patients with pre-existing glaucoma or optic nerve compromise.
The suction can lead to a common, temporary complication called a conjunctival hemorrhage, which appears as a red patch on the white of the eye. Another laser-specific issue is intraoperative miosis, or pupil constriction, which can happen due to the laser energy releasing inflammatory substances. This constriction can complicate the subsequent manual steps of the surgery.
In some instances, the laser-created capsulotomy (the opening to access the cataract) may be incomplete or feature small bridges of tissue, requiring the surgeon to manually complete the opening. If not managed carefully, these tags can lead to an anterior capsular tear, potentially compromising the structural integrity of the lens capsule and complicating the placement of the new intraocular lens. The precision of the laser’s corneal incisions can also be affected by minor eye movements or suction breaks, potentially requiring a shift back to manual techniques mid-procedure.
Patient Selection and Procedural Limitations
Laser cataract surgery is not suitable for all patients, as various pre-existing ocular conditions can prevent its use. The laser relies on clear transmission through the cornea, so patients with significant corneal scarring or opacities are not candidates because the laser energy cannot penetrate. Similarly, eyes with poor pupil dilation (less than 6 millimeters) cannot undergo the procedure safely, as the constricted pupil blocks the laser’s access to the lens.
The high pressure during the docking phase makes the procedure a relative contraindication for patients with advanced glaucoma or previous filtering surgeries. For many patients with routine cataracts, the clinical benefit of the laser method may be negligible. Outcome differences in final visual acuity between the laser and a skilled conventional surgeon are often minimal.
Paying the substantial added cost may not translate into a measurable improvement in vision, making the financial disadvantage an unnecessary burden. The technology cannot fully replace the surgeon; the lens material still needs to be removed via aspiration and a new lens inserted, meaning the overall procedure remains a combination of laser and manual steps.