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    Does FLACS cost, benefit outweigh manual? No!

    Increased cost, other limitations overshadow potential benefits of FLACS

    Femtosecond laser-assisted cataract surgery (FLACS) offers some advantages compared with a conventional manual procedure, particularly for certain patients. Currently, however, FLACS does not result in superior outcomes and it has drawbacks that outweigh its benefits, according to Rosa Braga-Mele, MD.

    “I am using FLACS, and I really like it, but FLACS adds financial and clinical challenges,” said Dr. Braga-Mele, professor of ophthalmology and vision sciences, University of Toronto, Ontario.

    Discussing cost, Dr. Braga-Mele noted data from multiple studies show that, at least initially, FLACS increases costs.

    “Theoretically, the extra costs can be passed on to the patient under certain insurance exceptions or as a refractive procedure,” she said. “However, I would urge surgeons who are considering the purchase of a femtosecond laser to perform a financial analysis for their center.”


    Clinical challenges

    Dr. Braga-Mele first cited a learning curve so that surgeons can initially expect to spend an additional 5 to 7 minutes on each case.

    The extra time needed should be considered with the effects FLACS has on workflow.

    “Surgeons need to think through logistical hitches to avoid bottlenecks,” she said. “Consideration has to be given to where the laser will be installed, including the potential need for a separate room. Scheduling will need to take into account how many surgeons will be using the laser and how many procedures will be booked.”

    Surgeons also need to be aware that femtosecond laser treatment induces prostaglandin release that may cause pupillary constriction. They should be prepared to manage miosis by having a pharmacological adjunct on hand.

    Awareness of other potential complications associated with FLACS supports the use of specific surgical techniques. Dr. Braga-Mele recommended pulling the laser-created capsulotomy centrally to minimize the potential for radial tears.

    Posterior capsule rupture

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