These are the advantages that are real and measurable.
A reproducibly round, sized and centred capsulotomy. A laser circle is more consistent than a free-hand tear. Where an IOL’s optical performance depends on the capsule overlapping its edge evenly — as with some premium lenses — that consistency has a rational basis.
Bladeless corneal incisions, cut to a planned architecture and depth.
Less ultrasound energy inside the eye. The pre-fragmented lens needs less effective phaco time, which in principle means less energy delivered near the corneal endothelium.
Precise arcuate incisions for low astigmatism, planned on the corneal map rather than judged by hand.
A slightly faster early visual recovery. A 2025 meta-analysis of 46 randomised trials (8,871 eyes) found FLACS gave significantly better corrected distance visual acuity at one week (p = 0.011).
Four independent, high-quality evidence sources — two systematic reviews and two large randomised trials — point the same way.
2025 meta-analysis
46 randomised trials · 8,871 eyes · Scientific Reports
No significant difference at any timepoint beyond one week — not in corrected distance visual acuity, not in uncorrected distance visual acuity, not in spherical equivalent, not in surgically induced astigmatism, and not in overall complications. Its conclusion, verbatim: “both techniques yielded comparable extended-term results encompassing visual outcomes, surgical efficacy, complications, and patient-reported outcomes.”
2023 Cochrane systematic review
42 randomised trials · 7,298 eyes of 5,831 adults
Concluded: “there is probably little or no difference between FLACS and PCS in terms of intraoperative and postoperative complications, postoperative visual acuity and quality of life.” It added that evidence from two studies suggests FLACS may be the less cost-effective option.
FEMCAT trial
907 patients · multicentre, participant-masked · The Lancet, 2020
Success rates were 41.1% with FLACS and 43.6% with conventional phacoemulsification — no significant difference (adjusted odds ratio 0.85, 95% CI 0.64–1.12). The authors’ conclusion: “Despite its advanced technology, femtosecond laser was not superior to phacoemulsification in cataract surgery and, with higher costs, did not provide an additional benefit over phacoemulsification for patients or health-care systems.”
FACT trial
785 UK patients · Ophthalmology, 2020
Found FLACS non-inferior — that is, as good, not better — at three months for vision, patient-reported health and safety.
We are not going to pretend otherwise. Here is what we take from it.
FLACS is not an upgrade that buys better vision.
If someone tells you the laser will make you see better than conventional surgery would, ask them for the trial. There isn’t one.
FLACS is a technique with specific indications.
The laser’s advantage is consistency of execution in the opening steps. There are eyes where that consistency is worth having — a dense cataract where reducing ultrasound energy matters, a compromised corneal endothelium, a premium lens whose centration depends on a precise capsulotomy, a patient in whom a free-hand capsulorhexis would be technically demanding. In those eyes we will recommend it, and we will tell you which of those reasons applies to you.
In a routine cataract in a healthy eye, a well-performed phacoemulsification by an experienced surgeon is an excellent operation, and the evidence says it will serve you as well.
That is not us talking you out of spending money. It is the reason we publish the trials.
What matters more than the machine is who is holding it.
The steps the laser does not perform — clearing the capsular bag, implanting and positioning the lens, managing anything unexpected — are still the surgeon’s, in FLACS exactly as in conventional surgery.
Vision Correction
Cataract
Retina
Glaucoma & Cornea
Paediatric & Speciality
Oculoplasty
