Abstract
Purpose :
With the prevalence of cataract surgery and increased patient expectations of improved vision, side effects increasing morbidity such as tear disorders should not be neglected. Several studies investigating the short-term effect of cataract surgery on Dry Eye Disease (DED) lack evaluation in the medium and longer term (beyond 3 months) and it was uncertain if dry eye parameters had returned to baseline. Hence, this study aims to evaluate the effects of cataract surgery on severity of clinical tear film parameters of patients with DED in the medium to long term period (6 months to 5 years) post-surgery.
Methods :
A cross-sectional study was conducted on 448 eyes on first visit to a tertiary clinic (224 eyes with cataract surgery within timeframe, i.e. pseudophakic dry eye group, 224 comparison eyes without such history, i.e. comparison dry eye group). Parameters evaluated include Ocular Surface Disease Index (OSDI), Schirmer’s I test score, Tear Break-up Time (TBUT), number of liquid expressing glands in lower lid, cornea fluorescein staining, corneal sensation, meibum character and follicular papillary reaction grade in the upper and lower fornices.
Results :
A significantly greater proportion of pseudophakic dry eye group (49%) experienced frequent blurred vision (≥1 episode per week) compared to dry eye control group (37%) (OR=1.57, 95%CI 1.07, 2.31). Those with ocular discomfort before surgery were more likely to experience blurring at least once a day. In addition, a significantly greater proportion of pseudophakic dry eye group (34%) had Schirmer’s I >8mm compared to the comparison group (24%) (OR=0.605, 95% CI 0.398, 0.921), though the difference was not clinically significant (7.51mm versus 6.51mm respectively, p>0.05). Other signs such as TBUT, number of liquid expressing glands in lower lid, cornea fluorescein staining, corneal sensation, meibum character and follicle grade did not differ between the two groups.
Conclusions :
While uncomplicated cataract surgery does not worsen signs of DED, up to half of participants experienced greater frequency of blurred vision 6 months to 5 years post-cataract surgery, especially in those with ocular discomfort suggestive of dry eyes prior to surgery. Counselling for increased risk of transient blurred vision post-cataract surgery and dry eye prevention measures should be undertaken, especially those with suggestive symptoms pre-operatively.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.