Laser Cataract Surgery May Generate pRNFL Thinning in Healthy Eyes

BETHESDA, MD – August 21: Opthamologist Dr. Daniel Pluznik uses a LensX state-of-the-art laser to perform part one of a two-step cataract surgery on Milford Best, 82 at Palisades Eye Surgery Center in Bethesda, MD on August 21, 2012. Cataracts are the most common surgery performed in Medicare and is the most common cause of blindness in the world. Pluznik performs about 350 of these surgeries a year, sometimes 12-15 a day at a length of 15 minutes each. (Photo by Linda Davidson / The Washington Post via Getty Images)
Thinner preoperative pRNFL is associated with thinning of the temporal quadrant, according to a report.

Femtosecond laser-assisted cataract surgery (FLACS) may result in thinning of the peripapillary retinal nerve fiber layer (pRNFL) in healthy eyes, according to a study published in the Journal of Glaucoma. 

The prospective cohort study included 261 eyes of 261 patients scheduled either for FLACS (222 eyes) or conventional phacoemulsification cataract surgery (CPCS) (39 eyes) between July 2017 and July 2018. All participants were aged 50 years or older, had age-related cataracts and no ocular diseases. FLACS was performed via the Ziemer LDV Z8 laser. Researchers measured average and quadrant pRNFL thickness using optical coherence tomography before surgery and at 1, 3, and 6 months postoperatively. They compared postoperative changes in pRNFL thickness within and between groups.

The researchers found that mean quadrant and average pRNFL thicknesses significantly increased after both surgeries (P <.001). However, the rate of clinically significant thinning 6 months after surgery was higher in the FLACS group (17.5%) compared with the CPCS group (5.1%).

FLACS eyes demonstrated a significant and stable decrease of average pRNFL thickness (P =.057), as well as a gradual decrease in pRNFL thickness in all quadrants (P ≤.018). CPCS eyes demonstrated an initial increase of pRNFL thickness, followed by a decrease solely in the nasal quadrant and average pRNFL. According to the report, preoperative pRNFL thickness was associated with temporal quadrant thinning (P =.04).

Limitations of the study include the relatively small sample size of patients with CPCS, possibility of skewed results due to missing data in both groups, failure to perform a visual field test, and researchers did not include a history of systemic diseases and medications or eyes with advanced cataracts. 

“The main strength of this study is that it is the largest to examine the effect of FLACS on pRNFL in healthy eyes, and provides the most detailed information in the field so far,” according to the researchers. “Further studies are needed to confirm the pRNFL thinning as it may have implications for the use of FLACS in glaucoma patients.”


Geyer O, Ben-Shaul O, Lux C, et al. Effect of femtosecond laser cataract surgery on peripapillary retinal nerve fiber layer thickness. J Glaucoma. 2022;31(5):340-345. doi:10.1097/IJG.0000000000002014