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  • AAO OTAC Refractive Management/Intervention Panel, Hoskins Center for Quality Eye Care
    Refractive Mgmt/Intervention


    A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel: Charles C. Lin, MD,1 Jennifer R. Rose-Nussbaumer, MD,1,2 Zaina N. Al-Mohtaseb, MD,3 Seth M. Pantanelli, MD, MS,4 Walter Allan Steigleman III, MD,5 Kathryn M. Hatch, MD,6
    Marcony R. Santhiago, MD,7 Stephen J. Kim, MD,8 Julie M. Schallhorn, MD9

    Ophthalmology, Vol. 129, 946-954, © 2022 by the American Academy of Ophthalmology. Click here for full access to the OTA.

    Purpose: To evaluate refractive outcomes, safety, and cost-effectiveness of femtosecond laser-assisted
    cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS).

    Methods: A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were
    reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies.

    Results: No significant differences were found in mean uncorrected distance visual acuity, best-corrected
    distance visual acuity, or the percentage of eyes within ± 0.5 and ± 1 diopter of intended refractive target between FLACS and PCS. Intraoperative and postoperative complication rates were similar between the 2 groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between 1 and 6 months. In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS.

    Conclusions: Both FLACS and PCS have similar excellent safety and refractive outcomes. At this time, one
    technique is not superior to the other, but economic analyses performed in some populations have shown that FLACS is less cost-effective.

    1Department of Ophthalmology, Byers Eye Institute, Stanford University, Stanford, California.
    2Francis I. Proctor Foundation, University of California, San Francisco.
    3Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
    4Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania.
    5Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida.
    6Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts.
    7Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil.
    8Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee.
    9Department of Ophthalmology, University of California, San Francisco, California.