ASCRS 2026: Light Adjustable Lens outcomes with femtosecond laser vs manual capsulotomy

Early postoperative refractive accuracy may be improved with femtosecond laser assistance in Light Adjustable Lens (LAL) cases, although the number of postoperative adjustments appears largely unchanged. Dan B. Tran, MD, of Coastal Vision Medical Group in Orange County, California, discussed whether femtosecond laser–assisted capsulotomy confers measurable advantages when used with the LAL. His presentation at the American Society of Cataract and Refractive Surgery (ASCRS) 2026 annual meeting in Washington, DC, April 10-13, focused on whether the laser improves early refractive precision, reduces the number of postoperative adjustments, and decreases chair time.

Tran framed the question around a practical issue in adjustable lens surgery. Because “the LAL adjustable lens could be adjusted after the procedure, to get the desirable refractive outcome,” the central issue is whether femtosecond laser assistance contributes additional value to the visual outcome process. He noted that prior studies suggest the laser may improve effective lens position (ELP) through a more precise capsulotomy, potentially translating to better refractive predictability in conventional IOLs.

He explained that the femtosecond laser enables a highly reproducible capsulotomy, with attention to “location, size, shape, and locations,” using three-dimensional reconstruction to center the opening relative to the lens. This may improve the uniformity of capsular contraction forces during healing and create “something more predictable” that could translate into better early visual outcomes.

To evaluate this, Tran retrospectively compared consecutive cases of femtosecond laser–assisted capsulotomy with LAL versus manual capsulotomy with LAL. Most patients elected laser treatment, with approximately an 80-plus to 20-plus patient split, roughly “three to one.”

A key end point was refractive accuracy immediately after surgery and before any LAL adjustment. Here, the femtosecond group performed better. The proportion of patients within 0.25 D of target was higher, described as “almost two-third versus half of the patient in the manual group.” Similarly, the proportion within 0.50 D was higher in the laser group, reaching “almost ninety percent,” compared with approximately 71% to 72% in the manual cohort.

After postoperative light adjustments, however, the average number of treatments was essentially unchanged: 1.5 in the femtosecond group versus 1.6 in the manual group, a difference Tran noted was not statistically significant. Still, he observed that “about 3% of the patients” in the laser cohort required fewer treatments, suggesting a modest reduction in chair time over a large case volume.

He also highlighted improved cylinder accuracy, noting that astigmatic correction appeared to “favor the femtosecond laser group,” with about a 10% difference between groups.

Tran concluded that while both approaches produced “happy result[s],” femtosecond laser assistance appears to provide a more precise starting refractive outcome, particularly for cylinder, with a slight reduction in the need for postoperative treatments.