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|Issue 77||March 2014|
A Systematic Review: Benefits and Harms of Femtosecond Laser-Assisted Cataract Surgery
Cataract surgery is a frequently performed operation in the VA healthcare system, 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 VA. This evidence review examined the potential benefits and adverse effects related to femtosecond laser-assisted cataract surgery (FLACS) relative to conventional cataract surgery, and will aid VA leadership in determining policy for use of this technology. In addition, meta-analyses were conducted of two commonly reported outcomes in femtosecond laser (FSL) and conventional cataract surgery procedures: corrected distance visual acuity (CDVA), and effective phacoemulsification time (EPT).
The VA Evidence-Based Synthesis Program located in Portland, OR reviewed 468 titles and abstracts from an electronic search of the literature, as well as 436 additional references through manual searching of reference lists, input from technical advisors, and reviewing conference proceedings of ophthalmalogic societies for recently unpublished or ongoing studies. After applying inclusion/exclusion criteria at the abstract level, 16 articles met review criteria. Based on this evidence, results are presented in the Summary, which is followed by several key questions providing more detailed information.
Key Question #1
Nine studies addressing the comparative effectiveness of FLACS versus conventional surgery were identified, including three small to medium-sized randomized controlled trials. However, six of these studies (and all three RCTs) were conducted at one university in Hungary, with all surgeries performed by the same surgeon using the Alcon LenSx laser. Overall, results show:
Key Question #2a
Seven studies were identified addressing adverse effects unique to FLACS. Sample sizes in these studies ranged from 25 to 1,300 patients, with follow-up periods extending from immediately following the procedure to three months post-operative. Results show:
Key Question 2b
Nine studies addressed the adverse effects of FLACS compared to conventional cataract surgery. Sample sizes in these studies ranged from 25 to 400 patients, with follow-up periods extending from one week to one year. Results show:
Key Question #3
Three studies reported outcomes relevant to the experience of the surgeon in performing the FLACS procedure. Sample sizes in these studies ranged from 200 to 1,300 patients, with follow-up periods extending from two weeks to three months. Overall, results show:
A cyberseminar session on this ESP Report will be held on April 29, 2014 at 2:00pm (ET). To register, go to the HSR&D Cyberseminar web page.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers — and to disseminate these reports throughout VA.
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This Management eBrief is a product of the HSR&D Evidence Synthesis Program (ESP). ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of the HSR&D Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers - and to disseminate these reports throughout VA.
See all reports online.