Higher Order Aberrations in Femtosecond Laser-Assisted Versus Manual Cataract Surgery: A Retrospective Cohort Study

To evaluate differences in higher order aberrations (HOAs) between femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery.

In this retrospective cohort study, consecutive patients undergoing FLACS or manual cataract surgery with implantation of an intraocular lens from January 2017 to February 2018 were recruited. Patients underwent aberrometry testing at least 2 months postoperatively. The primary endpoint was internal coma < 0.32 µm, and secondary outcomes included patient-reported vision quality. Generalized estimating equations accounting for within-patient correlation were used for analysis.

A total of 57 eyes underwent FLACS (mesopic pupil size: 4.74 ± 1.37 mm) and 50 eyes underwent manual cataract surgery (pupil size: 4.99 ± 1.24 mm). The proportion of eyes reaching internal coma < 0.32 µm was significantly greater following FLACS (54 of 57 eyes, 94.7%) relative to manual cataract surgery (39 of 50 eyes, 78.0%) (odds ratio [OR] = 5.08, 95% confidence interval [CI] = 1.24 to 20.85, P = .024). The median internal coma was 0.10 µm for FLACS and 0.12 µm for manual cataract surgery (P = .005). There were no significant differences in vision quality between treatments (P = .40). All eyes (n = 15) with satisfaction scores of 0 to 10 had internal coma < 0.20 µm, compared to those with scores of 11 to 20 (27 of 29 eyes, 93.1%), 21 to 30 (19 of 30 eyes, 63.3%), and > 30 (8 of 15 eyes, 53.3%) (P < .001). The average internal coma increased by a greater amount for manual cataract surgery than for FLACS for every increase in mesopic pupil size > 5.75 mm.

More eyes achieved internal coma < 0.32 µm following FLACS compared to manual cataract surgery. However, this does not account for improved patient-reported vision quality. There was a correlation between internal coma and patient-reported satisfaction, and eyes with excellent patient satisfaction all had internal coma < 0.20 µm. [J Refract Surg. 2019;35(2):102-108.].