Comparative visual outcomes of EDOF intraocular lens with FLACS vs conventional phacoemulsification

To investigate the visual quality after femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) with the implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) TECNIS Symfony. SETTING: Eye Center, the Second Affiliated Hospital of Zhejiang University, Zhejiang, China. DESIGN: Prospective cohort study. METHODS: Patients were given the option to choose FLACS or CPS and were implanted with a TECNIS Symfony. Main outcome measures were postoperative examinations that included defocus curves, contrast sensitivity (CS), optic path difference aberrometry scan, anterior segment photography, and questionnaires. RESULTS: 261 patients (261 eyes) were enrolled. The circularity index of FLACS was more precise than that of CPS (P = .001). FLACS demonstrated a significantly lower IOL decentration (P = .011) and IOL tilt (P = .009). FLACS presented a significantly lower total aberration (P < .001), higher-order aberrations (HOAs) (P = .001), coma (P = .001), and spherical aberration (P < .001). With IOL decentration of more than 0.40 mm, total internal aberration (P = .023) and HOAs (P = .045) were significantly deteriorated. As for defocus curve, FLACS was better at −1.00 diopter (P < .01). The FLACS group achieved higher CS at 6 to 18 cycles per degree under glare condition (P < .05). With regard to photic phenomena, the FLACS group received better outcomes (P < .05). CONCLUSIONS: With the implantation of an EDOF IOL, FLACS could precisely control the shape and size of the capsulotomy and induce a significantly better-centered IOL, leading to higher visual performance compared with CPS.