A cataract is a clouding of the eye’s naturally clear lens, which causes vision to become blurry, hazy, or less colorful over time. It develops as proteins in the lens begin to clump together, scattering light and preventing it from focusing correctly on the retina. Femtosecond Laser-Assisted Cataract Surgery (FLACS) is an advanced medical procedure that offers a high-precision, technology-driven method for removing the clouded lens and replacing it with an artificial intraocular lens (IOL). This technique represents a significant progression in ophthalmology, introducing automated accuracy to several steps that were traditionally performed manually.
Defining the Technology
The femtosecond laser is a specialized tool that emits ultra-short pulses of light, with each pulse lasting just one quadrillionth of a second (a femtosecond). This rapid pulse duration enables the laser to create precise cuts in tissue without causing heat damage to surrounding cells. The laser’s energy is focused to an exact point within the eye, where it causes a process called photodisruption.
Photodisruption generates tiny bubbles of gas and water vapor, separating tissue layers with micrometer-level precision. The laser delivers thousands of microscopic pulses in a computer-guided pattern, creating incisions and separations. The system is guided by real-time imaging, such as Optical Coherence Tomography (OCT), allowing the surgeon to map the eye’s structures and customize the procedure. This precise, bladeless approach distinguishes the femtosecond laser as a high-tech solution in cataract treatment.
Procedure Stages
The FLACS procedure begins with the patient positioned under the laser system, where a suction ring gently docks the eye to the device. The computer-guided laser then performs a series of pre-programmed steps on the anterior structures of the eye. The laser first creates precise, multi-plane corneal incisions, which serve as entry points for the surgeon’s instruments later in the procedure.
Following the incisions, the laser performs the capsulotomy, creating a perfectly circular opening in the lens capsule. This automated step is more accurate in size and centration than a manual technique, which is important for IOL stability and long-term performance. The laser’s third action is lens fragmentation, breaking the cloudy cataract into smaller, easily removable pieces.
The laser energy softens the cataract by creating a grid or pattern of cuts, which significantly reduces the amount of ultrasonic energy needed for the subsequent removal. Once the laser completes these steps, the patient is moved to an operating microscope for the remainder of the surgery. The surgeon then uses suction and a phacoemulsification probe to remove the fragmented cataract pieces before implanting the new artificial lens (IOL) into the lens capsule.
Comparison to Manual Surgery
The primary distinction between FLACS and traditional cataract surgery, known as phacoemulsification, lies in the method used for the initial steps. In manual surgery, the surgeon uses a handheld blade to create the corneal incisions, relying on their skill to achieve the desired size and architecture. FLACS replaces this manual step with a laser, which creates precise, self-sealing incisions planned to the micron level, often resulting in less corneal distortion.
Another major difference is the capsulotomy. Traditional surgery involves the surgeon manually tearing the capsule in a continuous, circular fashion, which can sometimes result in an opening that is not perfectly centered or sized. The femtosecond laser automates this step, producing a consistently centered and perfectly circular capsulotomy, which ensures better positioning and stability of the implanted IOL.
FLACS assists in fragmenting the cataract before removal, while manual surgery relies on a phacoemulsification probe using ultrasound energy. By pre-softening the lens, the laser allows the surgeon to use significantly less total ultrasound energy, or Cumulative Dissipated Energy (CDE). This reduction in energy leads to less stress on the delicate inner structures of the eye, particularly the corneal endothelial cells.
Post-Operative Expectations
The recovery period following FLACS is typically swift, with many patients observing a notable improvement in their vision within the first 24 hours. Most individuals are able to return to their normal daily routines, such as reading and light work, within one to two days. Full visual stabilization and complete recovery of the eye can take a few weeks to a couple of months.
Post-operative care involves the diligent use of prescribed eye drops, which are necessary to prevent infection and manage inflammation. Patients are advised to avoid strenuous activities, heavy lifting exceeding 20 pounds, and bending over for at least a week to prevent putting pressure on the eye. Temporary restrictions also include avoiding swimming, hot tubs, and eye makeup for about two weeks to minimize the risk of bacterial exposure. Follow-up appointments are scheduled to monitor the healing process.