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Large registry data provide a useful real-world complement to randomized trials of femtosecond laser-assisted cataract surgery (FLACS). A multicenter study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery matched 2,814 femtosecond-assisted cases with 4,987 conventional phacoemulsification cases across multiple countries. Visual acuity, refractive prediction error, and postoperative complications were compared. FLACS did not demonstrate better postoperative corrected distance visual acuity or refractive accuracy. The proportion of eyes within ±0.50 D of target was similar, while postoperative complications were lower in the conventional phaco group in this registry analysis. The practical message for cataract surgeons is that technology selection should not be driven solely by the promise of greater precision. Modern conventional phaco already provides excellent outcomes when performed with disciplined biometry, capsulorhexis, fluidics, and IOL positioning. FLACS may remain useful in selected cases where automated laser-assisted steps offer a procedural benefit, but the registry findings argue against assuming a universal outcome advantage. In patient discussions, clinicians can frame FLACS as an alternative surgical platform rather than an inherently superior replacement for standard phacoemulsification.
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Large registry data provide a useful real-world complement to randomized trials of femtosecond laser-assisted cataract surgery (FLACS). A multicenter study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery matched 2,814 femtosecond-assisted cases with 4,987 conventional phacoemulsification cases across multiple countries. Visual acuity, refractive prediction error, and postoperative complications were compared. FLACS did not demonstrate better postoperative corrected distance visual acuity or refractive accuracy. The proportion of eyes within ±0.50 D of target was similar, while postoperative complications were lower in the conventional phaco group in this registry analysis. The practical message for cataract surgeons is that technology selection should not be driven solely by the promise of greater precision. Modern conventional phaco already provides excellent outcomes when performed with disciplined biometry, capsulorhexis, fluidics, and IOL positioning. FLACS may remain useful in selected cases where automated laser-assisted steps offer a procedural benefit, but the registry findings argue against assuming a universal outcome advantage. In patient discussions, clinicians can frame FLACS as an alternative surgical platform rather than an inherently superior replacement for standard phacoemulsification.
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