OBJECTIVES:Recently, there has been increased interest in femtosecond laser assisted cataract surgery (FLACS) due to its potential for improved effectiveness, safety and efficiency. The current study systematically evaluated comparative efficacy, safety, and efficiency outcomes between LenSx FLACS and manual cataract surgery (MCS) in patients undergoing cataract surgery. METHODS:A systematic literature review was performed in Embase, Medline, and Cochrane databases (search period: 2010 – August 2018) using Ovid platform. Search results were limited to English articles only. Publications reporting on comparative efficacy, safety and efficiency data between LenSx and MCS procedures in age-related cataract surgery were included. Reviews, editorials, animal studies and in-vitro studies were excluded. Additionally, grey literature search and bibliography-guided search were performed, and conference proceedings (2013–2018) from annual congresses of European Society of Cataract & Refractive Surgeons and American Society of Cataract and Refractive Surgery were searched. Commonly reported outcomes were identified including best corrected visual acuity (BCVA), endothelial cell density, central corneal thickness (CCT), phacoemulsification time, effective phacoemulsification time (EPT) and cumulative dissipated energy (CDE). RESULTS:Fifteen studies that reported comparable outcomes were included. Both pre-SoftFit and post-SoftFit systems were included. With regards to CDE, LenSx had significantly lower CDE versus MCS (n=8). In majority of studies (n=5), EPT was significantly lower for LenSx compared to MCS with differences ranging from 0.8-10 seconds. Three studies compared and reported CCT for LenSx compared to MCS. Overall, CCT was comparatively thinner with LenSx versus MCS. Variation in study design, machine configuration, and reporting made it difficult to draw conclusions across remaining outcomes. CONCLUSIONS:Findings from this study suggest that LenSx achieves better results than MCS with regards to CDE, EPT and CCT. Upcoming studies of FLACS versus MCS, and between FLACS platforms, should aspire to utilize standardized metrics for outcomes, to ensure more accurate assessment of relative performance and treatment value.