OBJECTIVES: Femtosecond laser-assisted cataract surgery (FLACS) automates several steps of manual cataract surgery (MCS) which may provide advantages in clinical effectiveness and safety outcomes. A narrative umbrella review of systematic reviews and meta-analyses (MAs) was conducted to summarize the totality of evidence available for such outcomes.

METHODS: MEDLINE was searched for systematic reviews and MAs comparing FLACS and MCS using the terms “Femtosecond or femtolaser” and “cataract”, from 2014-01-01 to 2022-12-20.

RESULTS: The search returned eight MAs that studied clinical effectiveness or safety outcomes. Meta-analyses assessed a mix of randomized and non-randomized studies (6) or randomized controlled trials only (n=2). All reviews assessing mean phacoemulsification power (2), phacoemulsification time (4), corneal thickness at one day (3), and corrected distance visual acuity (DVA) at 6-months (2) found significantly more favorable outcomes for FLACS compared with MCS. Results favored FLACS but were mixed (significant; trending towards significance) for reduced endothelial cell loss overall (3; 1), lower corneal thickness overall (2; 1), and better corrected DVA at 1-week (2; 1). There was disagreement in the literature (FLACS significantly favored; no difference) for capsulorhexis circularity (4; 1), cumulative dissipated energy (2; 1), mean absolute error (4; 1) and uncorrected DVA (1;5). Results were mixed for the rate of complications (no difference, MCS significantly favored), but the majority of analyses found no difference in the rate of intraocular pressure (4; 1), corneal or macular edema (4; 1), or anterior (3; 2) and posterior capsular tears (3; 1), including the review with the lowest heterogeneity.

CONCLUSIONS: Conclusions generally favored FLACS, with good alignment between reviews. Greater consistency in outcomes reporting (definitions and timepoints) would help to support comparability within and between meta-analyses. Future assessment of this meta-analytic evidence with quantitative techniques would be valuable.