Femtosecond Laser-Assisted Cataract Surgery: Precision, Practice, and the Path to Personalization.

Abstract

To evaluate the current evidence and evolving role of femtosecond laser-assisted cataract surgery (FLACS) in modern ophthalmic practice, focusing on its precision, clinical outcomes, economic considerations, and potential for personalization. Perspective review synthesizing findings from key randomized controlled trials, meta-analyses, large-scale cohort studies, and health economic evaluations. This is a comprehensive literature review assessing visual and refractive results, complication rates, utility in challenging cases, efficacy in astigmatism management, and cost-effectiveness. Current evidence indicates that although FLACS offers superior precision in anterior capsulotomy and lens fragmentation, leading to reduced phacoemulsification energy and to potential early visual benefits, long-term visual and refractive outcomes are largely equivalent to those of conventional phacoemulsification cataract surgery in routine cases. FLACS demonstrates distinct advantages in challenging scenarios, such as hard nuclei, white cataracts, shallow anterior chambers, and posterior polar cataracts by improving safety and reducing endothelial cell loss. For astigmatism management, femtosecond laser-assisted arcuate keratotomy effectively corrects low-to-moderate astigmatism, although toric intraocular lenses remain superior for higher magnitudes. Economically, FLACS currently faces challenges regarding cost-effectiveness in public health systems, although workflow optimizations and selective application could improve its value proposition. FLACS represents a significant technological advancement that enhances procedural precision and reproducibility. It serves not as a universal replacement for conventional surgery but as a valuable complementary tool, particularly beneficial in complex cases and within the framework of personalized, refractive cataract surgery. Its future role will likely be defined by technological refinements, improved economic models, and strategic integration into tailored surgical planning.