Excerpt

The preferred method of removing cataracts in the developed world is phacoemulsification. Using this technique, ultrasonic energy softens the dense lens material of the cataract, which is then extracted from the eye with suction and irrigation. Current practice includes creating manual corneal incisions and anterior capsulotomies, followed by phacoemulsification. Recently these three manual procedures have been performed in an automated fashion with the use of the femtosecond laser (FSL). Several FSL systems have been approved by the FDA for use in the U.S. for some or all of these procedural steps in cataract surgery. FSL technology has been widely used in various refractive surgery applications in recent years. Studies have suggested decreased phacoemulsification energy use with FSL cataract surgery and have examined the potential advantages of more precise corneal incisions and capsulotomy formation.

Cataract surgery is a frequently performed operation in the VHA, with more than 49,000 performed in 2012. As a result, the VHA National Surgery Office has been tasked with making a recommendation regarding whether femtosecond lasers provide appropriate cost-benefit and risk-benefit ratios to support implementation for cataract surgery in the VA. The purpose of this systematic review is to examine the effectiveness and safety of femtosecond laser assisted cataract surgery (FLACS) relative to conventional cataract surgery. Key questions were developed in conjunction with the stakeholders which address the effectiveness, safety, adverse consequences and economic implications of adopting FLACS into the VA system.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • DISCUSSION
  • CONCLUSION
• BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • STUDY QUALITY
  • RATING THE BODY OF EVIDENCE
  • DATA SYNTHESIS
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1 What is the evidence that FLACS is associated with better patient outcomes than conventional cataract surgery?
  • KEY QUESTION 2A What are the adverse effects that have been reported for FLACS?
  • KEY QUESTION 2B What is the risk of adverse effects from FLACS compared to the risk associated with conventional cataract surgery?
  • KEY QUESTION 3 What is the evidence that the experience of the surgeon is associated with adverse effects of FLACS?
  • ONGOING STUDIES
• DISCUSSION
  • FUTURE STUDIES
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B INCLUSION/EXCLUSION CRITERIA
• APPENDIX C ELIGIBILITY CHARACTERISTICS OF STUDIES (PICOTS TABLE)
• APPENDIX D ASSESSMENT OF METHODOLOGIC QUALITY IN STUDIES OF FEMTOSECOND LASER ASSISTED CATARACT SURGERY
• APPENDIX E PEER REVIEW COMMENTS AND RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, M.D., M.C.R., Director

Suggested citation:

Quiñones A, Gleitsmann K, Freeman M, Fu R, O'Neil M, Motu'apuaka M, Kansagara D. Benefits and Harms of Femtosecond Laser Assisted Cataract Surgery: A Systematic Review. VA-ESP Project #05-225; 2013.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.