Femtosecond laser-assisted cataract surgery (FLACS)
In phacoemulsification, a modern cataract surgery, the cataract is liquified and removed by using high frequency ultrasound energy and replaced by implanting an artificial intra-ocular lens. However, some critical steps of the surgery like making the tiny incisions in the eye or the round opening in the cataract is done manually. In FLACS these critical steps are performed using an extremely sophisticated and precise laser called femto-second laser. The laser even makes the cataract softer, therefore reducing the energy needed for emulsifying the cataract and making the overall surgery safer for the eye. FLACS is particularly helpful when patients are being implanted with premium intro-ocular lenses like multifocals, which reduce or eliminate the need for spectacles after surgery. This is because the margin for error is very small with these premium lenses and FLACS ensures that the surgery is safe and predictable.
At LVPEI, 5-10% of cataract patients choose FLACS
Most reputed eye hospitals currently have a FLACS platform. This procedure is approved by the FDA and is likely to slowly replace conventional phacoemulsification. We are looking at a future where cataract surgery will be completely automated and 100% safe. At LVPEI Hyderabad, around 5-10% of our cataract patients choose to have FLACS done for them. Currently the main limiting factor is the extra cost involved, and unfortunately, this procedure is not covered by most medical insurances.
FLACS is much safer than conventional surgery
FLACS is much safer than conventional cataract/phacoemulsification surgery, because all the critical steps are performed with high precision using the femtosecond laser, and the chance of any inadvertent manual error is minimized. The procedure takes an extra five mins for each patient and is completely painless. There can be no greater endorsement of this technology than the fact I performed my mother’s cataract surgery in both eyes using FLACS with multifocal lenses, and today she enjoys perfect vision for both distance, intermediate and near and does not have to use glasses at all.
FLACS will grow in popularity
FLACS is a state-of-the art cutting edge technology that promises to make cataract surgery completely automated and error-free in the future and that would be fantastic for the patients. As this technology becomes mainstream and the costs slowly come down, more people will be able to avail of its benefits. I know of many practices where 20-30% of all cataract surgeries are now performed using FLACS and this number will only grow in the future.
One stumbling block
One problem I do foresee is the introduction of non-laser technology with similar sounding names that can be quite misleading for the patients. One recent example is Zepto-cataract surgery. Although it sounds as if zepto is more advanced than femto, it is actually a cumbersome technique of only making the round-opening in the cataract and does not involve any laser technology nor is it capable of making incisions or softening the cataract, all of which the femto does in a few seconds with immaculate precision.
Sayan Basu, MBBS, MS
Dr. Sayan Basu, is a clinician and scientist. He specializes in treating ocular surface diseases, corneal pathologies and cataracts. Dr Basu is a renowned corneal transplant surgeon and an expert in the state-of-the-art femtosecond laser-assisted cataract surgery (FLACS).
Tej Kohli Cornea Institute
L V Prasad Eye Institute (LVPEI), Kallam Anji Reddy Campus
L V Prasad Marg, Banjara Hills, Hyderabad.