By Dr. David Folden, MD | Twin Cities Eye Consultants
Patients often ask me whether laser cataract surgery is better than conventional manual cataract surgery. I’m always careful and thoughtful with my answer, since every patient’s eyes and expectations are unique. The surgical anatomy created by the laser is more consistently reproducible and precise when compared with the hands and eyes of the surgeon. The laser is also a sophisticated tool that helps correct focusing errors of the eye, including astigmatism, and may help reduce the need for glasses after surgery. Although these advantages exist, both approaches are safe and effective for removing the cataract and restoring the visual potential of the eye.
The Current State of Cataract Surgery
A cataract forms when the eye’s natural lens becomes cloudy. The natural lens sits behind the iris and pupil and helps focus light onto the retina. When that lens becomes cloudy, vision can become blurred, hazy, dim, or affected by glare.
Cataract surgery removes the cloudy natural lens and replaces it with a clear artificial intraocular lens, commonly called an IOL. The IOL is usually made of acrylic or silicone and is designed to restore clear focusing power inside the eye.
The surgery is highly successful, and both traditional cataract surgery and laser-assisted cataract surgery can produce excellent outcomes in terms of restoring the visual potential of the eye. However, refractive outcomes are still not perfectly predictable. Even small differences in the final postoperative position of the IOL and uncorrected astigmatism can alter the focusing result and affect how much a patient may depend on glasses after surgery.
To understand where the laser may make a difference, it helps to understand a few key parts of the eye and the surgery.
The natural lens is enclosed by a thin, clear membrane called the lens capsule. The front portion is called the anterior capsule, and the back portion is called the posterior capsule. Tiny fibers called zonules connect to the capsule and help anchor the lens centrally in the eye.
During cataract surgery, an opening is created in the anterior capsule to allow access for removing the cloudy lens material and implanting the IOL. When this step is performed manually, it is often referred to as a capsulorhexis. When it is created by a laser, the opening is often called a capsulotomy. The cataract is then removed using an ultrasound device that emulsifies and vacuums out the cloudy lens material. The IOL is inserted through the anterior capsule opening and then centered within the remaining capsular pocket.
How Laser Cataract Surgery Works
Femtosecond laser-assisted cataract surgery, often called FLACS, uses imaging, software, and a computer-guided laser to automate several steps of cataract surgery, including:
- Creating the capsulotomy
- Making the corneal incisions
- Making astigmatism-correcting corneal incisions
- Identifying and marking the axis of astigmatism for proper IOL placement
- Softening and dividing the lens before removal
In each of these steps, the laser performs work that was previously done entirely by hand.
Where the Laser Makes the Biggest Difference
There are two areas where laser cataract surgery can provide a visual advantage: capsulotomy precision and astigmatism correction.
Capsulotomy
The capsulotomy is the circular opening made in the anterior, or front, portion of the lens capsule. This opening allows the surgeon to remove the cloudy lens material and creates the opening through which the new intraocular lens is inserted and centered within the remaining capsular pocket.
When the capsulotomy is created by hand, it can be very effective, but the size, shape, and position of the opening can vary slightly from case to case. When the laser creates the capsulotomy, the opening is more consistent, reproducible, and precise in terms of size, shape, and centration.1,2
That consistency matters because the capsulotomy helps influence how the intraocular lens sits inside the eye after surgery. Ideally, the opening is large enough to safely remove the inner cloudy lens material, but small enough that the remaining capsule uniformly overlaps the edge of the intraocular lens implant. This overlap is important because, when created with an ideal diameter and centration, it helps support and center the lens.
If the capsulotomy is too large or poorly centered, the lens may not sit as predictably. Even small changes in lens position can affect the final focusing result, especially for patients who are trying to reduce their dependence on glasses.
My own research has focused on this relationship between capsulotomy size, lens position, and refractive outcome.3 The idea is that capsulotomy size may not just be a technical step in surgery. It may also be a refractive planning variable that helps determine how accurately the lens performs after surgery.
Astigmatism
Laser cataract surgery can also help manage and correct astigmatism. Astigmatism occurs when the front surface of the eye is misshapen, causing light to focus unevenly on the retina. This can contribute to blurred or distorted vision separate from the blur caused by the cataract itself.
During cataract surgery, the laser can create precise corneal incisions to help reduce low or moderate amounts of astigmatism.4 For higher levels of astigmatism, it supports accurate positioning of Toric intraocular lenses through laser-assisted capsular marking, a method that has been shown to improve alignment accuracy.5
Applications for Laser Capsulotomy and Astigmatism Correction
For patients choosing conventional manual cataract surgery with a standard intraocular lens, glasses are often still needed after surgery. In those cases, small differences in lens position or untreated astigmatism may not be a priority.
For patients choosing advanced laser cataract surgery with more sophisticated intraocular lenses, precise capsulotomy creation and accurate astigmatism correction become more important. These technologies can help patients receiving Toric IOLs for astigmatism, multifocal lenses such as PanOptix® Pro, TECNIS Odyssey™, and enVista® Envy™, extended depth-of-focus lenses such as TECNIS PureSee™ and Vivity®, or the Light Adjustable Lens™ (LAL®). These lenses are designed to perform best when they are positioned exactly where they were planned to be and with full correction of all focusing errors including astigmatism.
Other Considerations: Less Ultrasound Energy, Less Stress on the Eye
The laser can also reduce how much ultrasound energy is needed during surgery.
Before the ultrasound step begins, the laser pre-softens and divides the lens into smaller pieces. That means less energy and less surgical manipulation may be required to remove the cataract. Less energy means less heat and less mechanical stress inside the eye during the procedure.
The cells on the back surface of the cornea are particularly sensitive to this. They do not regenerate, so preserving them matters for long-term corneal health. Studies have found that laser cataract surgery may result in less damage to these cells compared with conventional surgery.6,7
For most patients with healthy corneas, this difference is modest. For patients with denser cataracts or existing corneal concerns, reducing the amount of energy used can be a meaningful advantage.
What the Studies Say About Long-Term Vision
Here is the nuance that often gets lost in the conversation about laser cataract surgery.
In terms of simply restoring the visual potential of the eye, laser-assisted surgery and conventional surgery produce similar long-term results. A large meta-analysis published in Ophthalmology reviewed more than 14,000 eyes and found that laser cataract surgery showed some advantages in certain early postoperative and technical measures, while overall visual outcomes were comparable between laser-assisted and manual cataract surgery.8
An experienced surgeon performing conventional manual cataract surgery can achieve the same excellent long-term outcomes as laser-assisted surgery in terms of restoring the patient’s visual potential.
Although the visual potential can be similar between both groups, the laser’s advantages show up in the technical aspects of the procedure. These include helping correct focusing errors such as astigmatism,4,5 creating more precise capsulotomies,1 supporting more consistent visual correction, and potentially reducing visual phenomena related to lens tilt or decentration over time.2
What the laser does is make certain steps more consistent and reduce some of the variables that come with manual technique. That consistency can be important for patients with higher expectations for their post-surgical vision.
Who Benefits Most from Laser Surgery
Patients choosing premium lenses. Toric, multifocal, EDOF, and Light Adjustable Lens™ options require precise positioning to work as designed.2,5 The capsulotomy precision that laser surgery provides makes it easier to deliver on the promise of those lenses.1,2
Patients with denser cataracts. The laser pre-softens the lens, which can reduce the amount of ultrasound energy needed.7,8 That means less stress on the surrounding tissue during surgery.
Patients with corneal concerns. Less ultrasound energy means less potential damage to the corneal cells.6,7 For patients who already have some corneal compromise, that protection matters.
Patients interested in managing and correcting astigmatism. Laser-assisted cataract surgery can help manage astigmatism by creating precise corneal incisions4 and supporting accurate placement of Toric intraocular lenses through laser-assisted capsular marking systems.5 For patients who want to reduce their dependence on glasses after cataract surgery, this added precision can improve the predictability of the final visual outcome.
Why the Surgeon Still Matters Most
Technology only goes so far. Surgeon experience and judgment remain the most important factors in cataract surgery outcomes.
A laser does not replace surgical skill. What it does is add a layer of precision and consistency to specific steps that previously depended entirely on the surgeon’s hands. In the hands of an experienced surgeon, both approaches can deliver excellent results.
The technical aspects of cataract surgery are a passion of mine. I am an active member of the American Society of Cataract and Refractive Surgery (ASCRS) and have performed more than 20,000 cataract and lens implant surgeries. I completed my training at the University of Minnesota, where I received the Harry Plotke Award for clinical excellence and the Harry Friedman Research Award. Recently, my research on laser capsulotomy precision and its effects on intraocular lens positioning was awarded Best Paper of Session (BPOS) at the 2026 ASCRS annual meeting in Washington, DC.3
At Twin Cities Eye Consultants, we have performed more than 150,000 cataract surgeries across our 11 Twin Cities locations. We offer both laser and conventional cataract surgery and recommend the approach that best fits each patient’s individual needs.
The Bottom Line
For most patients, both laser and conventional manual cataract surgery reliably improve vision and restore the visual potential of the eye with excellent long-term outcomes.8
Where laser surgery stands out is in surgical precision, astigmatism correction, and the consistency it brings to specific steps of the surgery, all of which can improve refractive predictability.1,2,3,4,5 The laser can also reduce ultrasound energy, which may reduce swelling and help speed visual recovery.6,7,8
These advantages become most meaningful for patients interested in reducing their dependence on glasses after cataract surgery and for those whose visual goals require a higher level of surgical predictability.
The best way to make an informed decision is a comprehensive eye exam and one-on-one consultation with your surgeon.
Schedule a Cataract Consultation at Twin Cities Eye Consultants
We are always accepting new patients, including those seeking cataract consultations across the Twin Cities and beyond. Your cataract surgeon and care team will walk you through your options and help you understand which approach makes the most sense for your eyes and your goals.
Call us at 612-999-2020 or contact our team to request an appointment.
References
- Friedman NJ, Palanker DV, Schuele G, et al. Femtosecond laser capsulotomy. Journal of Cataract & Refractive Surgery. 2011;37(7):1189-1198. doi:10.1016/j.jcrs.2011.04.022
- Kránitz K, Miháltz K, Sándor GL, Takacs A, Knorz MC, Nagy ZZ. Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy. Journal of Refractive Surgery. 2012;28(4):259-263. doi:10.3928/1081597X-20120309-01
- Folden D. The Effect of Capsulotomy Size on Effective Lens Position in Robotic Laser Cataract Surgery. Paper presented at: American Society of Cataract and Refractive Surgery Annual Meeting; April 10-13, 2026; Washington, DC. ASCRS listing
- Jones M, Hovanesian JA, Keyser A. Accuracy of the LaserArcs femtosecond cataract surgery arcuate incision nomogram in patients undergoing cataract surgery and astigmatism reduction. Clinical Ophthalmology. 2023;17:681-689. doi:10.2147/OPTH.S398334
- Schultz T, Hoffmann S, Dick HB. Comparison of Toric intraocular lens alignment between femtosecond laser-assisted capsular marking and digital marking. Journal of Cataract & Refractive Surgery. 2024;50(3):230-235. doi:10.1097/j.jcrs.0000000000001344
- Fan W, Yan H, Zhang G. Femtosecond laser-assisted cataract surgery in Fuchs endothelial corneal dystrophy: long-term outcomes. Journal of Cataract & Refractive Surgery. 2018;44(7):864-870. doi:10.1016/j.jcrs.2018.05.007
- Chen X, Chen K, He J, Yao K. Comparing the curative effects between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery: a meta-analysis. PLOS ONE. 2016;11(3). doi:10.1371/journal.pone.0152088
- Popovic M, Campos-Möller X, Schlenker MB, Ahmed IIK. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14,567 eyes. Ophthalmology. 2016;123(10):2113-2126. doi:10.1016/j.ophtha.2016.07.005
