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Owen J Drinkwater, Ashley R Brissette, Christopher E Starr; ASSESSING THE PREVALENCE OF ABNORMAL TEAR TESTING IN CATARACT SURGERY PATIENTS USING TWO POINT-OF-CARE DIAGNOSTIC TESTS. Invest. Ophthalmol. Vis. Sci. 2017;58(8):791.
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Ocular surface disease (OSD) can significantly impact pre-operative measurements for cataract surgery. The purpose of this study is to assess the prevalence of abnormal tear testing in pre-operative cataract surgery patients (pts) using two common point-of-care (POC) diagnostic tests and to assess the correlation between patient symptoms and objective test results.
A prospective observational study of 34 consecutive pre-operative cataract surgery pts was conducted. Pts with visually significant cataract were included for study at their pre-operative appointment. They were administered 2 questionnaires: the Ocular Surface Disease Index (OSDI) and the Symptom Assessment in Dry Eye (SANDE) questionnaire. All pts then underwent tear osmolarity (osm) testing (TearLabTM) and matrix metalloproteinase-9 (MMP-9) testing (InflammaDryTM) regardless of symptomatology and before the instillation of any drops or other testing. Primary outcome measures included tear film osm, tear MMP-9 level, and questionnaire scores.
Average age was 70.1 ± 7.7 years, and 59% of pts were female. At least 1 abnormal tear test was present in 76% of pts, while 35% of pts were abnormal for both tear tests. 15% of pts had abnormal tear osm (≥308 mOsm/L or inter-eye difference ≥8 mOsm/L) but were negative for MMP-9. An abnormal MMP-9 with normal osm was found in 26% of pts, and in 24% of pts both tests were normal. OSDI and SANDE symptom scores were well correlated (r=0.56, p<0.001). However, there was no significant association between OSDI scores (severe symptoms >33) and abnormal tear osm (p=0.42) or MMP-9 (p=0.63). SANDE scores (severe symptoms >50) also showed no significant association with osm (p=0.22) or MMP-9 levels (p=0.24). Mean OSDI and SANDE scores were similar between the subgroup of pts with 2 abnormal tear tests (37.48 ± 26.51 and 34.35 ± 31.63) and the subgroup that tested normal for both tear tests (34.75 ± 24.92 and 35.65 ± 30.63).
There is a high prevalence of OSD in pts who present for cataract surgery as measured by POC diagnostic tear tests. Signs and symptoms of OSD are often poorly correlated; this study shows a similarly poor correlation, suggesting symptomatology alone may miss affected pts. POC testing may be more useful in identifying early or asymptomatic OSD in pre-operative cataract surgery pts.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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