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  • FLACS Versus Phaco: Efficacy, Safety, and Cost

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, August 2022

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    For an Academy Ophthalmic Technol­ogy Assessment, Lin et al. reviewed and compared refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (PCS). According to their review of published studies, both procedures are safe and have excellent refractive outcomes, but economic analyses showed that PCS is less costly.

    The authors began this work by searching PubMed for randomized controlled trials in which the two types of surgery were compared. The search was conducted in August 2020 and was designed to capture all relevant studies published by then. Meta-analyses of primary literature were not considered. To qualify for in­clusion, a study’s primary objective must have been a comparison of refractive outcomes and/or safety for FLACS and PCS. Of the 727 abstracts identified for potential inclusion, 33 were suitable for full-text review. Twelve studies ulti­mately qualified for inclusion, all of which represented level 1 evidence. The minimum sample size for studies of refractive outcomes was 322, the num­ber needed to detect a 0.1 difference (5 letters) in logMAR VA between FLACS and PCS.

    The results showed no significant differences between the procedures in mean uncorrected distance VA, mean best-corrected distance VA, or the pro­portion of eyes within .5 or 1 D of the refractive target.

    Intraoperative and postoperative complications also were comparable: in most studies, there was no dif­ference in endo­thelial cell count at any assessment point through six months post-op. In large random­ized studies con­ducted in France and the United Kingdom, FLACS was more costly than PCS.

    This informa­tion helps to address some concerns that have surrounded FLACS since its inception in 2011. In the United States, most payers still do not cover FLACS, and its cost-effectiveness from a public health standpoint remains uncertain. The authors acknowledged that FLACS may be more beneficial in certain cases, such as those involving a trauma his­tory, zonulopathy, narrow angles, and other conditions that make it crucial to preserve endothelial cells. They rec­ommend comparing FLACS and PCS among patients with these conditions, as well as exploring the potential value of femtosecond technology in correct­ing corneal astigmatism.

    The original article can be found here.