ASCRS 2026: Gabriel Quesada, MD, on robotic femtosecond laser for LASIK flap creation

Advances in femtosecond laser technology continue to refine flap creation in LASIK, with increasing emphasis on precision and intraoperative imaging. Gabriel Quesada, MD, shared early experience with a robotic, dual-pulsed femtosecond laser platform designed to enhance accuracy and consistency in corneal flap creation at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 annual meeting, held April 10 to 13 in Washington, DC. The system integrates a robotic arm and anterior segment optical coherence tomography (OCT) imaging, enabling real-time visualization and measurement during the procedure. Quesada is in practice at Clínica Quesada in San Salvador, El Salvador.

Precision and flap customization

“This platform works with a robotic arm,” Quesada said, noting that “the precision and exact flap measurement that you can create is incredible.” In the study, flap thicknesses were created across a range of targets, including “one hundred and fifty microns… one hundred and thirty microns,” with the capability to extend to thinner flaps “from one hundred and ten microns or even ninety microns.”

OCT imaging and intraoperative measurement

Flap accuracy and stromal bed measurements were assessed using anterior segment OCT. Quesada reported that “the precision of the measurement that we have from the flaps and the stromal bed with OCT… was incredible,” adding that measurements were “more exact than the ones that are already established in the published data.”

The integrated imaging system was highlighted as a key differentiator. “I think that the most important part is the viewing of the cornea,” he said, emphasizing that the OCT system “is incredibly exact when you're measuring the cornea.” This real-time feedback was associated with consistent flap quality, with flaps described as “excellent flaps with very clear results.”

Clinical outcomes and flap quality

Clinical outcomes were reported as comparable to established LASIK benchmarks. “The visual acuity of all the subjects… was among the results that we have with LASIK surgery,” Quesada said. Supporting data from the study demonstrated predictable flap thickness with low variability and favorable early visual outcomes, without significant intraoperative complications reported in the initial series.

From cataract platform to corneal application

The platform’s development originated in cataract applications. “We began working with the LENSAR… to help them create the density measurement for the cataract surgeries,” he explained, with subsequent adaptation of the technology for corneal use. “We said, ‘Why don't we use it also in the cornea?’ And that's how the flaps began.”

From a surgical perspective, the combination of robotic control and imaging may contribute to procedural consistency. Quesada noted that “the images that we can get… make the surgery safer, even in the cornea or in the cataract.”

Overall, the findings suggest that enhanced imaging and robotic-assisted delivery may support precise flap creation and reproducible outcomes in LASIK, with ongoing evaluation needed to further characterize performance across broader patient populations.