Cataracts: Which surgery is best?

The Bottom Line

  • Cataract surgery is one of the most performed surgeries in the world, and there are now different options for types of surgeries available due to technological advancements.
  • Standard cataract surgery is covered by public insurance in Canada. Non-medically necessary add-ons, including using certain lasers, like femtosecond laser-assisted cataract surgery (FLACS), are not covered by public insurance.
  • There are likely no clinically important differences between standard cataract surgery and FLACS.
  • It is best to discuss all your options with your healthcare team to help you decide what surgery is best for you.

Cataract surgery. One of the most performed surgeries in the world (1). But which type of cataract surgery is best now that there are more options from technological advancements? With over 3.5 million people estimated to have cataracts in Canada—a condition that causes clouding of the eye lens and can lead to blindness—this question is surely a common one (1;2).

Standard cataract surgery, also known as ultrasound phacoemulsification cataract surgery (PSC), has been around for 40 years and is free in Canada, covered by public insurance like OHIP (1;3). However, non-medically necessary add-ons like the use of certain lasers and lenses cost extra and are not typically covered by public insurance (3). This includes femtosecond laser-assisted cataract surgery (FLACS), a newer technology aiming to provide better precision that first became available over 10 years ago.

PSC, the standard cataract surgery, involves a surgeon opening the outer layer or ‘skin’ of your lens capsule to take out the cloudy lens material and put in a clear artificial lens. The newer FLACS cataracts surgery uses lasers to make the surgery more automated and less manual for surgeons.

A recent systematic review provides important insights on how these two surgical techniques of standard PSC and FLACS compare to one another for people with cataracts (1).

What the research tells us

The review found that there are likely no clinically important differences between FLACS and standard PCS. This includes differences related to complications with surgery, eyesight, and quality of life. FLACS was found to be generally more expensive than PCS. Fortunately, complications in general for both types of surgeries were not common. While the certainty of the evidence ranged from low to moderate, these findings still help to provide some important insights (1).

As for cost considerations, the cost of optional add-ons such as FLACS can vary (4). Ultimately, the decision is yours for what type of surgery you would like to go with. It is best to go through all options, including details around costs, with your healthcare team to help you decide.

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Author Details


  1. Narayan A, Evans JR, O'Brart D, et al. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev. 2023; 6:CD010735. doi: 10.1002/14651858.CD010735.pub3.
  2. The Canadian Council of the Blind, Gordon KD. The cost of vision loss and blindness in Canada. [Internet] 2021. [cited July 2023]. Available from
  3. Ministry of Long-Term Care. Cataract and lens exchange surveys. [Internet] 2023. [cited July 2023]. Available from
  4. Eye Physicians and Surgeons of Ontario. Cataract surgery in Ontario. [Internet] 2018. [cited July 2023]. Available from

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