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.