Study: Visual acuity outcomes similar, but FLACS has some advantages

Reviewed by Jeffrey Whitman, MD

Femtosecond laser-assisted cataract surgery (FLACS) facilitated a precise capsulotomy and reduced phaco energy in a recent ongoing study with about 100 consecutive eyes, said Jeffrey Whitman, MD, Key-Whitman Eye Center, Dallas.

The study focuses on tracking the benefits of FLACS over manual cataract surgery in relation to visual acuity and refractive predictability in eyes receiving an accommodating IOL (Crystalens or Trulign, Bausch + Lomb).

The eyes in the prospective study were randomly divided to receive FLACS or manual surgery; in the FLACS arm, a femtosecond laser (Victus, Bausch + Lomb) was used for primary corneal incision, capsulotomy, and lens fragmentation. The same surgeon performed all cases, Dr. Whitman said.

At 90 days after surgery, distance, intermediate, and near visual acuity were measured. Postoperatively, the mean uncorrected distance visual acuity was nearly identical--20/30 in the laser group and 20/31 in the manual group.

In the laser group, 28% were 20/20 or better, compared with 30% in the manual group. In the FLACS group, 70% of patients were 20/30 or better compared with 64% in the manual group, and 80% were 20/40 or better, compared with 76% in the manual group.

The mean uncorrected intermediate visual acuity was nearly the same--20/17 and 20/18 in the laser and manual surgery groups, respectively. Ninety-eight percent were 20/25 or better in the laser group compared with 92% in the manual group, Dr. Whitman said.

For uncorrected near visual acuity, the mean was also almost identical--20/28 and 20/27 in the FLACS and manual groups, respectively. Twenty-eight percent versus 24% of patients were 20/20 or better in the FLACS versus manual groups, respectively. Seventy-four percent versus 84% were 20/30 or better; and 90% versus 92% were 20/40 or better, respectively.

FLACS benefit

Distance-corrected near visual acuity was 20/36 in the FLACS group compared with 20/37 in the manual group. Sixteen percent of eyes were 20/20 or better in the FLACS group compared with 10% in the manual group, and 48% were 20/30 or better versus 50%, respectively. Seventy percent of patients in the FLACS group were 20/40 or better compared with 76% in the manual surgery group.

The laser group had a higher percentage of patients with accuracy to refractive target, Dr. Whitman said, in which 80% were within 0.5 D compared with 72% in the manual group, and 92% in the laser group were within 0.75 D compared with 86% in the manual group.

Although both groups had excellent results, FLACS had an edge. “FLACS provides potential advantages over manual technique due to more precise capsulotomy and reduced phaco energy,” Dr. Whitman concluded. 

Jeffrey Whitman, MD

E: jeffrey.whitman@keywhitman.com

This article was adapted from Dr. Whitman’s presentation at the 2016 meeting of the American Society of Cataract and Refractive Surgery. He is a consultant and conducts research for Bausch + Lomb.