Femtosecond laser–assisted cataract surgery (FLACS) has received much buzz since it was introduced over a decade ago, but there is uncertainty about whether this high-tech, high-price approach offers any clinical benefits over conventional surgery using manual techniques. For this reason, researchers decided to study and report 12-month outcomes of a randomized controlled trial comparing FLACS and conventional methods.

Visual acuity, refraction, central corneal thickness, endothelial cell loss, adverse events, quality of life outcomes and patient-reported outcome measures (PROMs) were recorded for 400 patients (single eye surgery for each).

There were no differences in corrected or uncorrected acuity, corneal thickness (compared to pre-op), endothelial cell loss (compared to pre-op and one month post-op), residual refractive cylinder, SE refractive error from target refractions and changes in PROM indices.

The authors concluded that FLACS was not superior to conventional phaco, as it did not provide any benefits in outcomes and it incurred higher costs. A little more than half (58.5%) of the 400 patients attended a 12-month follow-up exam.

“Our results indicated that both groups had excellent visual and refractive outcomes at 12 months with no statistically significant difference in any of the tested parameters,” the authors explained in their study. “Although validated cataract surgery-specific PROMs at one month postoperatively have been reported, this is the first time the same PROMs at 12 months postoperatively have become available” for a study of femto cataract vs. conventional approaches. “In contrast with other studies, we did not find that FLACS resulted in more predictable refractive outcomes.”

Visual outcomes remain unchanged and, moreover, the femto approach wasn’t any safer, they found. “The rate of onset of new visually significant comorbidities in the fellow eye between four weeks and 12 months was not significantly different between the FLACS group and the [conventional phaco] group.”

Stanojcic N, Roberts HW, Wagh VK, et al. A randomised controlled trial comparing femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: 12-month results. Br J Ophthalmol. Epub ahead of print.