Laser Cataract Surgery (FLACS) in Turkey: How It Compares with Standard Phaco

If you are researching laser cataract surgery in Turkey or elsewhere, you will often see it presented as a more advanced version of the standard operation. The reality is more nuanced. In femtosecond laser-assisted cataract surgery (FLACS), a laser takes over some of the steps a surgeon otherwise performs by hand, but the cataract is still removed with ultrasound and the same artificial lenses are implanted.

This page explains what the laser actually does, what large independent trials found, and when it may be worth discussing with your surgeon. For the operation as a whole, see the main guide to cataract surgery.

What is femtosecond laser-assisted cataract surgery?

A femtosecond laser delivers extremely short pulses of infrared light that separate tissue with high precision. In cataract surgery it can perform four tasks:

• corneal incisions — the small entry wounds at the edge of the cornea;
• arcuate incisions — curved cuts in the cornea that can reduce mild astigmatism;
• anterior capsulotomy — the round opening in the front of the lens capsule;
• lens fragmentation — dividing and softening the cataract so that less ultrasound work is needed.

After the laser stage, the operation continues as a standard phacoemulsification: the surgeon removes the lens fragments with an ultrasound probe, cleans the capsule and implants the intraocular lens. FLACS is therefore not a different operation but standard surgery with some steps automated.

What happens during a laser-assisted operation?

1. Preparation. As for standard surgery, the pupil is dilated and the eye is numbed with drops.
2. Laser stage. You lie under the laser while a small interface holds the eye steady and a built-in imaging system maps its structures; the surgeon then plans and applies the laser treatment.
3. Surgical stage. The surgeon opens the laser-made incisions, lifts out the disc of capsule and removes the softened cataract with ultrasound.
4. Lens implantation. The artificial lens is injected into the capsular bag, and the operation is completed exactly as in standard phaco.

What does the evidence show?

Several large, independent studies have compared FLACS directly with standard phacoemulsification.

The Cochrane review (2023) pooled 42 randomized trials including 7,298 eyes of 5,831 people. Vision after surgery differed by about 0.01 logMAR — roughly one letter on the eye chart, which is not clinically important (moderate-certainty evidence). Tears in the back of the lens capsule may be slightly less frequent with the laser, about 4 fewer per 1,000 operations, but the certainty of this estimate is low. Swelling of the central retina (cystoid macular edema) did not differ, and FLACS was more expensive and less cost-effective.

FEMCAT (France), published in The Lancet in 2020, randomized 907 patients (1,476 eyes) at five university hospitals. A combined measure of success at three months was reached in 41.1% of patients after FLACS and 43.6% after standard phaco — no significant difference. There were no severe laser-related adverse events, and standard surgery was the more cost-effective option.

FACT (United Kingdom) randomized 785 patients at three NHS hospitals. Three months after surgery, uncorrected distance vision was 0.13 logMAR with the laser and 0.14 with standard phaco, and neither vision with glasses nor the 12-month results differed significantly. Capsule rupture occurred in no laser cases and in two standard cases. FLACS cost on average £167.62 more per patient and was not cost-effective.

The first cataract guideline of the European Society of Cataract and Refractive Surgeons (ESCRS, 2024) concludes that conventional and femtosecond laser-assisted cataract surgery are both safe and effective procedures.

When might the laser be considered?

Because the evidence shows no average benefit, the case for FLACS rests on particular circumstances in which a surgeon judges that one of its features could help:

• A highly reproducible capsule opening. The laser creates the capsulotomy and incisions with precise, repeatable dimensions.
• Mild astigmatism. Laser arcuate incisions are one way to reduce it; the alternative is a toric lens, which European guidance suggests considering for corneal astigmatism of 1.0 diopter or more.
• Less ultrasound energy. Softening the lens beforehand may reduce the ultrasound energy needed. In theory this could protect a fragile cornea — for example in Fuchs endothelial dystrophy, where high ultrasound energy is one of the factors that stresses the cornea's inner cell layer — but a clinical advantage has not been proven.

These are judgment calls rather than evidence-based rules, and the added cost has to be weighed against a benefit that trials have not demonstrated for routine cases.

Are there downsides?

The laser stage proved safe in the trials, and overall complication rates were similar to standard surgery. The main downside is cost: the Cochrane review, FEMCAT and FACT all found FLACS less cost-effective than standard phacoemulsification. If you are offered laser-assisted surgery, it is reasonable to ask:

• What exactly will the laser do in my eye?
• What benefit do you expect for me specifically?
• How much does it add to the price, and what would the result likely be without it?

Laser cataract surgery, YAG laser and LASIK are different

Three quite different eye lasers are often confused:

• The femtosecond laser in cataract surgery assists the cataract operation itself, as described above.
• The Nd:YAG laser is used months or years after cataract surgery to clear a clouded capsule behind the implant, in a few minutes and without an incision — see secondary cataract.
• Excimer and femtosecond lasers for LASIK or SMILE reshape the cornea to correct short- or long-sightedness in eyes without cataract — see RLE vs LASIK.

Laser cataract surgery in Turkey: discussing the options in Antalya

Whether a clinic offers laser-assisted surgery depends on its equipment, so when you compare quotes — in Antalya or anywhere else — check whether a laser fee is included and what it would add for your eyes. Prof. Türkoğlu evaluates your eyes, explains the options and the evidence in plain language, and plans the operation with you. For most patients, the decision that shapes everyday vision most is the choice of lens and its focus; see choosing a lens and the cost guide.