Advanced Surgical Technology
Femtosecond Laser-Assisted
Cataract Surgery
Computer-guided laser precision for the most demanding steps of cataract surgery — delivering less corneal energy, better IOL centration, and reproducible outcomes no hand alone can match.
What Is FLACS?
Precision That Goes Beyond the Human Hand
Femtosecond laser-assisted cataract surgery (FLACS) uses an ultrafast, computer-controlled laser to perform the most technically demanding preparatory steps of cataract surgery with sub-micron accuracy. The laser fires pulses measured in femtoseconds — one quadrillionth of a second — creating tissue separations so precise they are invisible to the naked eye.
At Brazos Eye Surgery, FLACS is integrated with Dr. Swann's bi-manual microincision technique — combining laser precision with the lowest-energy phacoemulsification approach available. The result is a procedure that is gentler on the cornea, more reproducible, and better suited to premium IOL outcomes than conventional surgery alone.
This is not a marketing upgrade. The reduction in cumulative ultrasound energy entering the eye during laser-assisted surgery is measurable and clinically meaningful — particularly for patients with dense cataracts, reduced corneal endothelial cell counts, or Fuchs dystrophy, where every unit of energy saved is a unit of corneal health preserved.
Step-by-Step
How FLACS Works
From imaging to IOL placement, here is exactly what happens during a femtosecond laser-assisted cataract procedure at Brazos Eye Surgery.
3D Imaging & Surgical Mapping
Before the laser touches the eye, an integrated optical coherence tomography (OCT) system captures a real-time 3D map of the entire anterior segment — corneal thickness, anterior chamber depth, lens position, and capsule anatomy. Every laser parameter is calculated from this image, not estimated by hand.
Laser Capsulotomy
The laser creates the circular opening in the front of the lens capsule (the capsulotomy) with sub-micron positional accuracy. A perfectly centered, perfectly circular capsulotomy is one of the most critical factors in correct IOL centration — and therefore your final visual result. Manual capsulotomies, no matter how skilled the surgeon, have inherent variability the laser eliminates.
Lens Fragmentation
The laser pre-segments the cataract into small, precise fragments using a programmed pattern tailored to the density of your specific cataract. When the ultrasound probe (phaco) enters the eye, most of the work is already done. This dramatically reduces the amount of phacoemulsification energy — and therefore heat and mechanical stress — delivered inside the eye.
Corneal Incisions
The laser creates the main surgical incision and any side-port incisions with precise depth, length, and architecture. Laser incisions are more reproducible than hand-crafted blade incisions, self-seal more reliably, and induce less unintended astigmatism.
Arcuate Relaxing Incisions (Optional)
For patients with corneal astigmatism who are not receiving a toric IOL — or as a complementary correction alongside one — the laser can create precise arcuate incisions at exact arc lengths and depths that are simply not reproducible with a manual blade. This is a level of astigmatism management previously available only with dedicated laser systems.
Phacoemulsification Completion
With fragmentation complete and incisions made, Dr. Swann removes the pre-softened lens segments using bi-manual microincision phacoemulsification — the lowest-energy technique available. The IOL is then inserted and positioned within the laser-created capsulotomy.
Clinical Advantages
Why the Laser Matters Clinically
These are not theoretical benefits. Each advantage below has a direct, measurable impact on surgical safety, corneal health, and visual outcomes.
Less Ultrasound Energy
Laser fragmentation pre-softens the cataract before the phaco probe enters the eye, reducing the total cumulative dissipated energy (CDE) by a measurable, significant amount. Less energy means less thermal stress to the cornea.
Preserved Endothelial Cells
The cornea's endothelial cells — the inner layer that keeps it clear — do not regenerate. Every surgery causes some cell loss. Femtosecond laser combined with bi-manual technique minimizes that loss, preserving your corneal reserve for life.
Precise IOL Centration
A laser-created capsulotomy is statistically more circular and more accurately centered than a manual one. Better centration means the IOL sits exactly where it was designed to sit — which directly affects how well premium lenses perform, especially multifocal and EDOF IOLs.
Reduced Transplant Risk
By reducing energy, preserving endothelial cells, and screening every patient with specular microscopy, our protocol has a demonstrated impact on reducing the rate of post-cataract corneal decompensation — a complication that often leads to an unnecessary corneal transplant.
Consistent, Reproducible Results
Human hands — even the most skilled — have inherent variability. The laser does not. Every incision, capsulotomy, and fragmentation pattern is executed exactly as planned, every single time.
Optimized for Premium Lenses
If you are choosing a multifocal, EDOF, or light-adjustable IOL, laser precision is especially important. These lenses have tight centration requirements that are best met with a laser-created capsulotomy rather than a manual one.
The Evidence
Less Energy. More Corneal Cells Preserved. Fewer Transplants Needed.
Multiple peer-reviewed studies have demonstrated that femtosecond laser-assisted cataract surgery produces statistically significant reductions in cumulative dissipated energy (CDE) compared to conventional phacoemulsification alone. Lower CDE correlates directly with better endothelial cell survival — and endothelial cells are the cells that keep your cornea permanently transparent.
Reduction in phaco energy in laser-fragmented dense cataracts vs. conventional technique
Measurably better endothelial cell preservation at 1, 3, and 6 months post-op in FLACS vs. manual
Reduced corneal decompensation events, particularly in patients with pre-existing endothelial compromise
Is FLACS Right for You?
Ideal Candidates for Laser-Assisted Surgery
While most cataract patients can benefit from FLACS, the following groups have the most to gain from the laser's precision and energy-reduction advantages.
Patients choosing a premium IOL (multifocal, EDOF, toric, or LAL)
Patients with astigmatism who want arcuate laser correction
Dense cataracts requiring maximum energy reduction
Patients with Fuchs dystrophy or reduced endothelial cell counts
Patients who have had previous corneal refractive surgery (LASIK, PRK)
Anyone who wants the most precise, most reproducible technique available
Not sure if you are a candidate? Your evaluation at Brazos Eye Surgery includes a full pre-operative assessment — corneal mapping, endothelial cell count, and IOL planning. Dr. Swann will give you a direct recommendation based on your anatomy and your goals, not a protocol.
See It in Action
FLACS Procedure Demonstration
Watch a demonstration of femtosecond laser-assisted cataract surgery — from 3D imaging and laser execution through phacoemulsification and IOL placement.
FLACS Procedure Video
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Common Questions
Frequently Asked Questions
Does femtosecond laser cataract surgery hurt?
No. The laser portion of the procedure is entirely painless. You will feel a light suction sensation for about 30 seconds while the laser performs its steps. The rest of the procedure uses topical anesthetic eye drops only — no needles.
Is FLACS covered by insurance?
The femtosecond laser is considered a premium technology upgrade and is not covered by Medicare or standard insurance. The standard cataract surgery portion is covered. The laser upgrade fee is discussed clearly at your consultation, and financing options are available.
How is FLACS different from LASIK?
Both use femtosecond lasers, but for completely different purposes. LASIK uses a femtosecond laser to create a corneal flap for vision correction. FLACS uses a femtosecond laser inside the eye to assist with cataract removal — specifically for capsulotomy, lens fragmentation, and corneal incisions.
Is FLACS right for every patient?
Most cataract patients are good candidates. Certain conditions — such as very small pupils, very advanced cataracts, or specific corneal irregularities — may affect candidacy. Dr. Swann will evaluate your specific anatomy at your consultation and give you an honest recommendation.
Does the laser replace the surgeon?
No. The laser performs specific preparatory steps under Dr. Swann's direct supervision and control. The surgeon still performs the cataract removal, lens placement, and all critical judgment calls. Think of the laser as a precision tool that enhances what a skilled surgeon can accomplish.
Ready to Learn More?
Schedule Your Cataract Consultation
Dr. Swann will review your cataract, your cornea, your prescription, and your lifestyle — then give you a clear, honest recommendation for the procedure and lens that will serve you best for the rest of your life.