Is Laser Assisted Cataract Surgery FLACS worth it?
Posted , 7 users are following.
I ran into this article which offers some thoughts on the value of FLACS in cataract surgery. It can cost an extra $1000 per eye to get it, so is it worth it? Not wanting to spoil the suspense but this surgeon's opinion after using it, is "NO". There is one caveat though. If laser surgery is what your surgeon does, and you don't want it, then find another surgeon. You do not want to force a surgeon to use a procedure they are not skilled in. That would work the other way too. You would not want to force a surgeon that is skilled in manual incisions to use a laser they are not skilled at.
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Is Laser-Assisted Cataract Surgery Better Than Traditional Cataract Surgery? by Alyssa Hoehn, MD Feb 5, 2020
1 like, 15 replies
stefan64833 RonAKA
Edited
Insurance companies don't pay for it in cataract surgery for a reason. No conclusive data from trials showing better outcomes to justify cost.
RebDovid RonAKA
Posted
According to the American Academy of Ophthalmology Cateract in the Adult Eye Preferred Practice Pattern (2021), at p. 8: "Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and the precision of the corneal incisions. It may also reduce the amount of ultrasonic energy required to remove a cataract. However, the technology is not yet cost-effective, and the overall risk profile and refractive outcomes have not been shown to be superior to that of standard phacoemulsification."
dave29862 RonAKA
Edited
All reputable peer review articles will say there is No advantage to the patient.
https://www.aao.org/eyenet/article/largest-meta-analysis-compares-cataract-sx
The cynics will say the advantage will be to the surgeon who may be charging a higher fee for using the technology
karbonbee RonAKA
Edited
In Canada, surgeons who perform cataract surgery in hospitals usually have to do it manually, as very few hospitals here have the equipment onsite to do visual laser assisted operations. The surgeon I went with offered the laser package, but like you said it would have cost another $2,000 for both eyes, bringing my out of pocket expenses up to $7,000 for both eyes to be done in a private clinic. I didn't have the extra money, and my surgeon was more than happy to do it manually, as he was used to doing hospital surgeries anyway. As you know, my surgeries went extremely well with just manual insertion, so I'm glad I didn't waste money I didn't have. Like other commenters, I had read (and watched) multiple reviews prior to my surgeries by surgeons in North America and internationally comparing the two methods, and the consensus seemed to be that they didn't find the extra cost worth it, and that in difficult surgeries, they found that manual insertion provided better outcomes overall. Interestingly enough, these surgeons found that the eye was less stressed when done manually. I'd have to look it up again, but I read a couple of papers that said that in general, less vitreous gel seemed to be lost with manual surgery as opposed to laser assisted. Excess loss of vitreous gel is linked to retinal detachment and PCO post surgery.
soks karbonbee
Posted
vitreous gel is not lost during cataract surgery as long as the capsule is intact which is the case in most cases. laser has nothing to do with it. the vitreous gel is tucked safely behind the capsule.
karbonbee soks
Edited
Well, many experts would disagree with you. When I looked up retinal detachment post cataract surgery, which I am a high risk of, pretty much all of the articles referred to loss of vitreous gel during the surgery being a main cause. The wall loosens with age and the pressure of removing the old lens during surgery will remove amounts of it. Manual extraction was shown to lose less than the automated laser.
"Vitreous loss during cataract extraction occurs at a rate of between 0.45% and 14.7%.1 This rate is dependent on the experience of the surgeon and the complexity of the procedure. Thus, higher-volume cataract surgeons have a lower rate of this complication.2
Vitreous loss is associated with greater rates of vision-threatening conditions, such as retinal detachment, cystoid macular edema, and endophthalmitis. Unfortunately, all cataract surgeons will experience vitreous loss at some point, so knowing how to manage this complication appropriately is necessary."
Moderator comment: I have removed the links as they were edited to try to get past moderation. You can post any links in the site but please just post the correct link. If they do not breach T&Cs they will be approved. Pubmed links will not go for moderation and will post immediately.
soks karbonbee
Posted
i saw your link before it went for moderation. it talks about retina detachment caused by vitreous loss. it does not talk about femto or laser.
how exactly will femto cause vitreous loss without a capsule rupture can you please explain?
karbonbee soks
Edited
Can you please first provide some backgrounding, research, for your early statement that is is only affected in very specific circumstances.
soks karbonbee
Posted
"Can you please first provide some backgrounding for your early statement."
sure. vitreous gel is behind your posterior capsule. during cataract surgery the capsularhexis (the cut) is made in the anterior capsule to remove the lens. the posterior capsule remains intact.
if the posterior capsule breaks there is vitreous loss and they have to do vitrectomy to prevent retinal detachment and other issues. i am asking you to explain why femto laser will cause vitreous loss. does it rupture the posterior capsule? if so i have not seen that evidence but would love to see it if it exists.
you are probably concerned about retina detachment because you ate a high myope. i am concerned about it due to family history.
Lynda111 karbonbee
Posted
Search "vitreous loss causes eight year analysis" which showed the rate of vitreous loss was 3.2%. This a 2018 article. It occurs most often in those under 40 or with pre-existing ocular issues, or with inexperienced cataract surgeons.
Lynda111
Posted
Also read an article I cited earlier "Frontiers laser cataract surgery" showing no benefit to laser cataract surgery. This is a 2023 article. Your article was dated 2009
Lynda111 RonAKA
Posted
If you Google. " Frontiers laser cataract surgery" you will get a long Feb. 2023 article that goes into more detail about laser cataract surgery but comes to. the conclusion as the article Ron cited. In the USA. Medicare will not cover it and neither will most private insurance plans.
RebDovid Lynda111
Posted
As I've mentioned before, the American Academy of Ophthalmology is of opinion that, while femtosecond laser-assisted cataract surgery has been shown to have some benefit, "the technology is not yet cost-effective, and the overall risk profile and refractive outcomes have not been shown to be superior to that of standard phacoemulsification."
Search: "Cataract in the Eye Preferred Practice Pattern". See p. 8.
Lynda111 RebDovid
Posted
Yes, Ron, the article I cited came to the same conclusion as the AAOO. It just goes into more detail.