If you have been diagnosed with a cataract, you may come across different names for cataract surgery and wonder which procedure you actually need. Cataract surgery is not a single technique. Surgeons can use different approaches to remove the cloudy natural lens and replace it with an artificial intraocular lens (IOL).
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The three approaches commonly discussed are phacoemulsification, femtosecond laser-assisted cataract surgery, and extracapsular cataract extraction. They differ mainly in how the cloudy lens is removed and how the eye is accessed. If you are looking for a broader overview of the procedure, you can also explore our Cataract Surgery guide.
What Are the 3 Main Types of Cataract Surgery?
Although cataract surgery techniques can be described and classified in different ways, these three approaches are important to understand:
- Phacoemulsification
- Femtosecond laser-assisted cataract surgery
- Extracapsular cataract extraction
Today, phacoemulsification is the most commonly performed technique in many settings. Laser-assisted surgery uses a femtosecond laser for selected steps of the operation, while extracapsular extraction may be considered when the cataract is particularly advanced or when phacoemulsification is not the preferred approach.
1. Phacoemulsification
Phacoemulsification, often simply called “phaco,” is the standard cataract surgery technique used in many patients. During the procedure, the surgeon makes a small opening in the eye and uses an ultrasonic instrument to break the cloudy natural lens into smaller pieces.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
These fragments are then removed from the eye. Once the cataract has been removed, an artificial intraocular lens is placed inside the eye to replace the focusing function of the natural lens.
Why is phacoemulsification commonly used?
- It uses a relatively small incision.
- The cloudy lens can be broken into small pieces before removal.
- The incision often does not require stitches.
- It generally allows relatively quick recovery.
- It can be combined with different types of intraocular lenses depending on the patient's visual needs.
2. Femtosecond Laser-Assisted Cataract Surgery
Femtosecond laser-assisted cataract surgery, sometimes referred to as FLACS, uses a specialized laser to perform certain steps that would otherwise be carried out manually with surgical instruments.
The laser can be used for steps such as creating precise corneal incisions and making an opening in the capsule surrounding the natural lens. It can also help fragment the cataract before the remaining lens material is removed.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The cloudy lens is still removed and replaced with an artificial intraocular lens. In other words, the laser does not replace the entire cataract operation; it assists the surgeon with selected parts of the procedure.
What is different about laser-assisted surgery?
The main difference is the technology used during particular surgical steps. The femtosecond laser can create highly precise incisions and lens fragmentation patterns. However, laser-assisted cataract surgery is not automatically the best choice for every patient. Whether it offers a meaningful advantage depends on factors such as the patient's eye condition, the type of cataract, the surgeon's assessment and the technology available.
3. Extracapsular Cataract Extraction
Extracapsular cataract extraction is another way of removing a cloudy lens. Instead of breaking the entire lens into very small pieces for removal through a small incision, the surgeon removes the cloudy lens while leaving the posterior portion of the lens capsule in place.
Because the lens is removed in a larger piece, the incision is generally larger than the incision used for modern phacoemulsification. The incision may therefore require stitches, and recovery can take longer.
When might extracapsular extraction be considered?
This technique may be useful in selected situations, particularly when a cataract is very dense or when the surgeon determines that conventional phacoemulsification is not the most suitable approach. It is used less frequently than phacoemulsification in modern cataract surgery, but it remains an important surgical technique in appropriate cases.
How Do These Three Approaches Compare?
| Feature | Phacoemulsification | Femtosecond Laser-Assisted Surgery | Extracapsular Cataract Extraction |
|---|---|---|---|
| How the cataract is removed | Lens is broken into small pieces using ultrasound and removed | Laser assists with selected surgical steps, followed by lens removal | Cloudy lens is removed through a larger incision |
| Incision | Small | Small | Larger |
| Laser used | No | Yes | No |
| Stitches | Often not required | Usually not required for the small laser-created incisions | May be required |
| Recovery | Generally relatively quick | Generally relatively quick | Usually longer |
| Typical role today | Common standard technique | Selected patients and settings | Selected cases, including some advanced cataracts |
Is Laser Cataract Surgery Completely Different From Phaco?
Not exactly. This is one of the most common points of confusion. Femtosecond laser-assisted cataract surgery and phacoemulsification are not necessarily two completely separate operations with completely different goals.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
With laser-assisted surgery, the laser performs or assists with certain stages of the operation, while the surgeon continues to remove the cataract and implant the artificial lens. Phacoemulsification may still be used to remove lens material after laser fragmentation. Therefore, the term “laser cataract surgery” does not mean that the laser independently removes the entire cataract.
What Happens After the Cataract Is Removed?
Regardless of the surgical approach, the cloudy natural lens needs to be replaced if the goal is to restore the eye's focusing ability after cataract removal.
The surgeon usually implants an intraocular lens, or IOL, inside the eye. The type of IOL can vary depending on the patient's vision, eye measurements, lifestyle and visual priorities. Different IOL options can provide different types of vision, so choosing the lens is an important part of cataract surgery planning.
Which Type of Cataract Surgery Is Best?
There is no single technique that is best for every patient. For many people, phacoemulsification is an appropriate and well-established option. Laser-assisted surgery may be considered when its additional precision is relevant to the patient's circumstances and the technology is available. Extracapsular extraction may be appropriate for selected advanced or technically challenging cataracts.
The choice depends on more than the patient's preference. Your ophthalmologist will consider the density and type of cataract, the condition of the cornea and other structures of the eye, previous eye procedures, other eye conditions and the overall surgical requirements.
Does the Type of Surgery Affect Recovery?
Yes, the surgical approach can influence early recovery. Modern small-incision techniques such as phacoemulsification generally allow patients to resume many normal activities relatively quickly. Laser-assisted cataract surgery also uses a small-incision approach.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Extracapsular extraction involves a larger incision and may require a longer period for the eye to heal. Visual recovery and activity restrictions can therefore differ between patients. Recovery also depends on the individual's eye health and whether there are any complications or additional procedures involved.
What About the Risks?
Cataract surgery is generally a successful procedure, but like any eye surgery, it carries potential risks. Possible complications can include infection, inflammation, bleeding, changes in eye pressure, retinal problems, swelling of the retina or cornea, and problems involving the implanted lens. Serious complications are uncommon, but the risk profile can vary depending on the patient's eye health and the complexity of the surgery.
The Bottom Line
The three cataract surgery approaches commonly discussed are phacoemulsification, femtosecond laser-assisted cataract surgery and extracapsular cataract extraction. Phacoemulsification uses ultrasound to break the cloudy lens into small pieces and is the most commonly used approach in many modern cataract surgeries.
Femtosecond laser-assisted surgery uses a laser to assist with selected stages of the procedure but does not replace the surgeon or the entire cataract operation. Extracapsular extraction removes the lens through a larger incision and is now generally reserved for selected cases. The right approach depends on the cataract, the condition of the eye and the surgeon's assessment rather than simply choosing the newest technology.
