A prospective randomized trial compared femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification over 12 months. Four hundred patients were randomized, with outcomes including unaided visual acuity, refraction, corneal thickness, endothelial cell loss, adverse events, and patient-reported quality of life. At 12 months, mean unaided distance visual acuity was essentially comparable between FLACS and conventional surgery, with no significant difference between groups. The study therefore did not show a clinically important long-term visual advantage for FLACS in routine cataract surgery. The findings are relevant when counseling patients about what femtosecond assistance can and cannot be expected to add beyond modern phacoemulsification. For surgeons, the evidence supports a selective rather than automatic approach to adopting FLACS, especially when cost, operating-room workflow, and case complexity are considered. FLACS can still have technical advantages, including automated capsulotomy and lens fragmentation, but these should be balanced against the absence of a clear 12-month superiority signal in routine cases. The study reinforces the importance of matching technology to the individual cataract, surgical goals, and available resources rather than assuming that greater automation necessarily produces better final vision.