Robotic Cataract Surgery? The Truth About FLACS That Every Cataract Patient Should Know

“Robotic cataract surgery” sounds like a procedure where a robot performs the entire operation. But is that actually what happens?

The answer is NO- not exactly.

FLACS, or Femtosecond Laser-Assisted Cataract Surgery, is an advanced form of cataract surgery in which a femtosecond laser assists the surgeon with certain precise steps of the procedure. The surgeon remains in control throughout the operation.

So, why is FLACS sometimes called “robotic cataract surgery”? And what does the laser actually do?

Let’s understand the truth in simple language.

What Is FLACS Cataract Surgery?

FLACS stands for Femtosecond Laser-Assisted Cataract Surgery.

It combines the expertise of an experienced cataract surgeon with the precision of a computer-controlled femtosecond laser.

In conventional cataract surgery, several steps are performed manually by the surgeon using specialized surgical instruments. With FLACS, the femtosecond laser can assist with selected steps before the surgeon completes the remaining parts of the procedure.

This means FLACS is better described as laser-assisted cataract surgery rather than a completely robotic operation.

Is FLACS Really Robotic Cataract Surgery?

This is where the terminology can become confusing.

FLACS is sometimes popularly referred to as “robotic cataract surgery” because the laser system uses advanced imaging, computer-controlled technology and highly precise laser pulses to perform selected surgical steps.

However, there is no autonomous robot independently performing the complete cataract operation.

The cataract surgeon remains responsible for planning the procedure, operating the laser system, removing the cataract, selecting and positioning the intraocular lens (IOL), and managing the patient's eye throughout surgery.

So, if you hear the term “robotic cataract surgery”, remember that it generally refers to the advanced computer-controlled laser assistance used during FLACS, not a robot replacing the surgeon.

How Does FLACS Work?

FLACS uses a femtosecond laser to assist with specific steps of cataract surgery.

1. Detailed Eye Assessment

Before surgery, the patient's eyes are carefully examined. Measurements and imaging help the surgeon understand the eye's anatomy and determine the appropriate surgical plan and intraocular lens.

2. Bladeless Corneal Incision

One of the important features of FLACS is that the femtosecond laser can create the corneal incision with computer-guided precision instead of making this particular incision manually with a surgical blade.

This is why FLACS is often described as a bladeless laser-assisted cataract procedure.

3. Precisely Centred Capsulotomy

The natural lens is surrounded by a thin capsule. During cataract surgery, the surgeon needs to create an opening in the front portion of this capsule to access the cloudy lens.

With FLACS, the femtosecond laser can create a precisely sized and centred capsulotomy according to the surgical plan.

4. Lens Fragmentation

The laser can also assist in breaking up or fragmenting the cloudy natural lens before the surgeon removes it.

This can reduce the amount of mechanical work required during the subsequent phacoemulsification step, depending on the patient's eye and cataract.

5. Cataract Removal and IOL Implantation

After the laser-assisted steps, the surgeon completes the cataract removal procedure and implants the selected intraocular lens (IOL).

The type of IOL depends on several factors, including the patient's eye measurements, eye health, lifestyle, visual expectations and suitability for different lens technologies.

What Are the Potential Benefits of FLACS?

FLACS is designed to provide computer-controlled laser assistance during selected steps of cataract surgery.

• Laser-assisted corneal incision
• Precisely planned capsulotomy
• Computer-guided surgical precision
• Laser-assisted lens fragmentation
• Potential reduction in some manual surgical steps
• Integration with detailed pre-operative eye measurements

However, it is important to understand that advanced technology does not automatically mean that FLACS is the best choice for every cataract patient.

The suitability of FLACS depends on the patient's eye condition, cataract characteristics, corneal health, previous eye procedures, measurements and overall surgical plan.

FLACS vs Conventional Cataract Surgery: What's the Difference?

Both conventional cataract surgery and FLACS aim to achieve the same fundamental goal: remove the cloudy natural lens and replace it with an artificial intraocular lens.

The major difference is how certain surgical steps are performed.

Feature	Conventional Cataract Surgery	FLACS
Corneal incision	Performed manually by the surgeon	Can be created using a femtosecond laser
Capsulotomy	Created manually	Can be laser-assisted and computer-guided
Lens fragmentation	Primarily performed using phacoemulsification	Can be assisted by the femtosecond laser before phacoemulsification
Surgeon involvement	Essential	Essential
Technology	Advanced surgical instruments	Advanced imaging + femtosecond laser + surgical instruments

Neither approach should be considered universally superior for every patient. The right procedure depends on the individual eye and the surgeon's assessment.

Does FLACS Mean the Surgery Is Completely Blade-Free?

FLACS is commonly described as a bladeless or laser-assisted cataract surgery because the femtosecond laser can perform certain incision-related steps.

However, “bladeless” should not be interpreted as meaning that no surgical instruments are used at any stage.

The surgeon still performs important parts of the cataract procedure, including removing the cataract and placing the intraocular lens.

Is FLACS Safer Than Conventional Cataract Surgery?

Safety in cataract surgery depends on many factors and not just the technology being used.

These include:

• The patient's overall eye health
• The type and hardness of the cataract
• Corneal and retinal health
• Accurate pre-operative measurements
• Appropriate IOL selection
• The surgeon's experience and surgical planning
• Proper post-operative care

FLACS provides an additional level of laser-assisted precision for selected surgical steps, but it does not eliminate the risks associated with cataract surgery.

A proper examination is therefore essential before deciding whether FLACS is appropriate.

Who May Be Suitable for FLACS?

Many patients with cataracts may be considered for FLACS, but suitability cannot be determined simply by age or cataract severity.

A cataract specialist may consider FLACS after evaluating:

• Type and density of the cataract
• Corneal condition
• Eye measurements
• Previous eye surgeries
• Retinal health
• Other eye diseases
• Preferred IOL and visual requirements

Your ophthalmologist can determine whether FLACS is appropriate after a comprehensive eye examination.

What About the Cataract Lens or IOL?

Removing the cataract is only one part of cataract surgery. The cloudy natural lens is replaced with an artificial intraocular lens.

Depending on the patient's eye condition and visual requirements, different IOL options may be considered, including:

• Monofocal lenses
• Multifocal lenses
• EDOF lenses
• Toric lenses
• Other advanced IOL technologies where clinically appropriate

The most expensive lens is not necessarily the best lens for every patient. IOL selection should be based on the patient's eye measurements, lifestyle, expectations and medical suitability.

FLACS Is Not Just About the Laser

One of the biggest misconceptions about advanced cataract surgery is that the machine alone determines the outcome.

In reality, technology and surgical expertise work together.

Accurate diagnosis, appropriate patient selection, detailed measurements, surgical planning, laser technology, IOL selection and the surgeon's experience all contribute to the overall treatment.

FLACS at Save Sight Centre, Delhi

At Save Sight Centre Eye Hospital, Delhi, FLACS is performed using advanced femtosecond laser technology along with comprehensive cataract evaluation and surgical planning.

FLACS with the Z8 femtosecond laser is available at Save Sight Centre in North Delhi. The procedure can assist with selected steps such as laser-assisted corneal incision, capsulotomy and lens fragmentation before the surgeon completes cataract removal and IOL implantation.

The hospital also provides different cataract surgery options and IOL choices, allowing the treatment plan to be selected according to the patient's individual eye condition and visual requirements.

Important: The decision to undergo FLACS should be made only after a detailed examination and discussion with a qualified cataract surgeon.

Frequently Asked Questions About Robotic Cataract Surgery and FLACS

Is robotic cataract surgery performed by a robot?

No. FLACS is not a completely autonomous robotic surgery. A femtosecond laser and computer-guided technology assist the surgeon with selected steps, while the cataract surgeon remains in control of the procedure.

What does FLACS stand for?

FLACS stands for Femtosecond Laser-Assisted Cataract Surgery.

Why is FLACS called robotic cataract surgery?

It is sometimes called “robotic cataract surgery” because advanced computer-controlled laser technology assists with precise surgical steps. However, this does not mean that a robot independently performs the entire operation.

Is FLACS completely bladeless?

The femtosecond laser can perform certain incision-related steps without a traditional surgical blade. However, FLACS still involves surgical instruments and active participation by the cataract surgeon.

Is FLACS better than normal cataract surgery?

FLACS offers laser assistance for selected surgical steps, but it is not automatically better for every patient. The most appropriate procedure depends on the patient's eye condition, cataract characteristics, measurements and surgical requirements.

Does FLACS remove the cataract using a laser?

The femtosecond laser can assist with lens fragmentation, but cataract removal is completed by the surgeon using the appropriate surgical technique, including phacoemulsification where indicated.

Can I choose a multifocal or EDOF lens with FLACS?

Potentially, yes. Different IOL options may be available depending on the patient's eye health, measurements, visual requirements and suitability. Your cataract surgeon should recommend the appropriate lens after evaluation.

Is FLACS suitable for everyone with cataracts?

No. Patient suitability varies. A comprehensive examination is required to determine whether FLACS is appropriate for a particular patient.

The Bottom Line

FLACS is advanced laser-assisted cataract surgery and not a robot replacing the cataract surgeon.

The femtosecond laser can assist with selected steps such as corneal incision, capsulotomy and lens fragmentation with computer-guided precision. The surgeon continues to play the central role in planning and performing the operation.

If you are considering cataract surgery, don't choose a procedure simply because it sounds more advanced. Ask your ophthalmologist which technology is appropriate for your eyes, why it is recommended, what type of IOL is suitable for you, and what benefits you can realistically expect.

For cataract evaluation and information about FLACS at Save Sight Centre Eye Hospital, Delhi:

Call: 7873222000 | 011-4700-2220
Visit: A-14, Adarsh Nagar (Opp. Adarsh Nagar Metro Station), Delhi-110033

This article is intended for general educational purposes and should not be considered a substitute for an individual examination or medical advice from a qualified ophthalmologist.