OBJECTIVES

To conduct a targeted literature review evaluating the current burden of traditional cataract surgery (with manual marking) and the outcomes associated with digital image-guided systems (DIGS).

METHODS

A targeted review of the literature was undertaken using MEDLINE. The review targeted: 1) publications quantifying the burden of traditional cataract surgery (with manual marking) for Toric IOL implantation, and 2) publications evaluating the outcomes of cataract surgery with DIGS.

RESULTS

There were seven studies included in this study, six prospective studies and one meta-analysis. Transcription errors, manual marking inaccuracies, and variabilities from incision size and implantation location were the biggest drivers of burden of traditional cataract surgeries. Transcription errors included incorrect measurement transcription, errors in handwritten results, and illegible writing. Measurement inaccuracies were found to be attributable to movement by the patient, marking pens, and experience of the marker. Additionally, difficulties in accounting for cyclotorsion when making corneal incision and aligning the IOL were observed. Use of DIGS was found to be safe, as or more effective, and more efficient alternative to manual marking. Of the five head-to-head prospective studies, three studies observed significant improvement in accuracy, IOL alignment, and/or visual quality (Strehl Ratio and Modulation Transfer Function). The DIGS significantly reduced Toric IOL misalignment, post-operative astigmatism, and difference vector compared to manual marking in the meta-analysis.

CONCLUSIONS

This review found a significant burden associated with traditional cataract surgery, and DIGSs to be safe and effective, while also providing surgeons and practices with increased efficiency.