An Updated Umbrella Review Comparing the Safety and Effectiveness of Femtosecond Laser-Assisted Cataract Surgery with Manual Cataract Surgery

Author(s)

Pan SM1, Ainslie-Garcia M2, Ferko N2, Hsiao CW1, Cheng H1
1Alcon Vision LLC, Fort Worth, TX, USA, 2EVERSANA, Burlington, ON, Canada

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.

Conference/Value in Health Info

2023-05, ISPOR 2023, Boston, MA, USA

Value in Health, Volume 26, Issue 6, S2 (June 2023)

Code

CO227

Topic

Clinical Outcomes, Study Approaches

Topic Subcategory

Clinical Outcomes Assessment, Clinician Reported Outcomes, Literature Review & Synthesis

Disease

Sensory System Disorders (Ear, Eye, Dental, Skin), Surgery

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