Evolution of Cataract Surgery – Femtosecond Laser Assisted Cataract Surgery (FLACS)

Since its inception in 2001, the National Health Group (NHG) Eye Institute has continued to address the increasing demand for eye care services, and areas of its research and training.

It incorporates Tan Tock Seng Hospital’s (TTSH) Department of Ophthalmology as its flagship clinical unit, and delivers quality tertiary and primary eye care to patients in Singapore and the region. With more than 32 fellowship-trained consultants on-board, the Institute covers the entire spectrum of ophthalmic subspecialties, providing comprehensive diagnosis and advanced treatment for both common and complex eye diseases.


In part three of the ‘Eye Discoveries’ series by the NHG Eye Institute, we will be taking a look at the evolution of cataract surgery, and the benefits conferred to patients and surgeons, through the introduction of Femtosecond Laser Assisted Cataract Surgery (FLACS).

Cataract surgery has evolved rapidly over the years. The last few years have seen the advent of a new technology called FLACS, which promises advantages to both the patient and surgeon.

Femtosecond lasers emit ultra-short pulses of energy similar to those used in LASIK. The speed and accuracy of the laser enables it to cut eye tissue with great consistency and precision. With FLACS, this automated laser can be used to create cornea wounds, open the lens capsule and fragment the cataract into tiny pieces — steps traditionally done by the surgeon manually. It can also be used to reduce astigmatism during cataract surgery. All this is achieved through high resolution scans of the eye during the laser process. To complete the surgery, phacoemulsification is used to remove the cataract fragments, using ultrasound energy.

Femtosecond laser techniques allow for more precise and consistent procedures. Although it is not possible to completely avoid human errors, even the most complex cases can benefit from FLACS, with reduced risk of surgical complications. This offers a greater level of safety to both the patient and surgeon alike. During cataract surgery, a circular opening on the lens capsule (capsulorrhexis) needs to be created. The capsulorrhexis created by the laser is shown to be consistently more circular than a manually-performed one. In addition, as all corneas experience some degree of endothelial cell loss after phacoemulsification during cataract surgery, lower amounts of ultrasound energy expended in FLACS may also reduce the risk of corneal endothelium injury. All these translate to potential improved visual outcomes for the patient.

FLACS is an advanced and exciting technology that offers various advantages. It is going to change the way we routinely perform cataract surgery. Looks like the time when a patient says that he had his cataract ‘lasered away’ has finally arrived.

By Dr Yeo Tun Kuan, Consultant, Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital