title: A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted versus Phacoemulsification Cataract Surgery.
abstract: OBJECTIVE
  To evaluate visual outcomes after femtosecond laser-assisted cataract surgery (LCS) with phacoemulsification cataract surgery (PCS).
  
  
  METHODS
  Prospective, multicenter, comparative case series.
  
  
  METHODS
  Consecutive patients undergoing femtosecond LCS or PCS with intraocular lens insertion.
  
  
  METHODS
  A total of 1876 eyes of 1238 patients (422 male and 772 female) who underwent cataract surgery between January 2012 and June 2014 were included in the study: 1017 eyes from center A and 859 eyes from center B. Cases underwent clinico-socioeconomic selection. Patients with absolute LCS contraindications were assigned to PCS; otherwise, all patients were offered LCS and elected on the basis of their decision to pay (the out-of-pocket cost for LCS). Demographic and postoperative data were collected to determine differences between groups.
  
  
  METHODS
  Six-month postoperative visual and refractive outcomes. Masked subjective refractions were performed 2 to 6 months postoperatively.
  
  
  RESULTS
  There were 988 eyes in the LCS group and 888 eyes in the PCS group. Baseline best-corrected visual acuity (BCVA) was better in LCS compared with PCS (20/44.0 vs. 20/51.5; P < 0.0003). Preoperative surgical refractive aim differed significantly between groups (LCS -0.28 vs. PCS -0.23; P < 0.0001). More patients who received LCS had Toric lenses implanted compared with PCS (47.4% vs. 34.8%; P < 0.0001). Postoperative BCVA was better after LCS (20/24.5 vs. 20/26.4; P = 0.0003) with a greater proportion of LCS cases achieving BCVA >20/30 (LCS 89.7% vs. PCS 84.2%; P = 0.0006) and 20/40 (LCS 96.6% vs. PCS 93.9%; P = 0.0077). However, PCS cases had more letters gained compared with LCS cases (13.5 vs. 12.5 letters; P = 0.0088), reflecting baseline BCVA differences. Mean absolute error was higher in LCS compared with PCS (0.41 diopters [D] vs. 0.35 D; P < 0.0011). The percentage of eyes within 0.5 D of error from preoperative aim refraction was higher in the PCS group (LCS 72.2% vs. PCS 82.6%; P < 0.0001).
  
  
  CONCLUSIONS
  Femtosecond LCS did not demonstrate clinically meaningful improvements in visual outcomes over conventional PCS.
authors.affiliation: Tasmanian Eye Institute, Launceston, Tasmania, Australia.
authors.forename: Shaun Y P
authors.initials: SY
authors.lastname: Ewe
authors.affiliation: Tasmanian Eye Institute, Launceston, Tasmania, Australia.
authors.forename: Robin G
authors.initials: RG
authors.lastname: Abell
authors.affiliation: Tasmanian Eye Institute, Launceston, Tasmania, Australia.
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Oakley
authors.affiliation: Tasmanian Eye Institute, Launceston, Tasmania, Australia.
authors.forename: Chris H L
authors.initials: CH
authors.lastname: Lim
authors.affiliation: Tasmanian Eye Institute, Launceston, Tasmania, Australia.
authors.forename: Penelope L
authors.initials: PL
authors.lastname: Allen
authors.affiliation: Newcastle Eye Hospital Research Foundation, Newcastle, New South Wales, Australia.
authors.forename: Zachary E
authors.initials: ZE
authors.lastname: McPherson
authors.affiliation: Newcastle Eye Hospital Research Foundation, Newcastle, New South Wales, Australia.
authors.forename: Anupam
authors.initials: A
authors.lastname: Rao
authors.affiliation: Newcastle Eye Hospital Research Foundation, Newcastle, New South Wales, Australia.
authors.forename: Peter E J
authors.initials: PE
authors.lastname: Davies
authors.affiliation: Tasmanian Eye Institute, Launceston, Tasmania, Australia. Electronic address: eye.vote@me.com.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Vote
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D018918:Phacoemulsification / Q000379:methods; D011184:Postoperative Period; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*