Failure to treat ocular surface dysfunction prior to cataract surgery can have a significant adverse effect on surgical planning and outcomes. However, despite the poor correlation between the symptoms of ocular surface dysfunction and objective measures of the condition, presurgical testing is not typically performed in the absence of patient-reported symptoms.  

New findings suggest that more patients should be screened. The study, published in September 2018 in the Journal of Cataract & Refractive Surgery, found that as many as 80 percent of patients who present for cataract surgery evaluation have ocular surface dysfunction.

“There are a number of studies showing that ocular surface dysfunction can negatively affect outcomes at the time of cataract surgery,” explains the study’s first author, Preeya K. Gupta, MD, a corneal specialist at the Duke Eye Center. “So we’re trying to identify who’s more likely to have this problem, and, if someone is susceptible, treat them beforehand by doing a better job of diagnosing.”

The study included 120 patients from two physicians’ practices at Duke and Weill Cornell Medicine. Researchers examined several measures of ocular surface dysfunction: slitlamp evaluation findings of the corneal surface, OSDI or SANDE questionnaire score, tear osmolarity, and tear matrix metalloprotease-9 (MMP-9) test results.

The overall prevalence of ocular surface dysfunction was 80 percent. Of the 56.7 percent of patients who had no preexisting diagnosis of the condition, 81 percent had at least one abnormal tear film test.

Interestingly, traditional methods of screening, such as looking for corneal staining or using questionnaires, failed to identify many cases of the condition. By contrast, 83 percent of patients who scored “normal” on their questionnaire had either an abnormal osmolarity or abnormal MMP-9 test (or both). These results confirm that newer point-of-care tests such as tear osmolarity and MMP-9 allow for rapid and objective assessment of the ocular surface.

Based on these findings, Gupta says, it is reasonable to recommend that cataract surgeons screen all patients prior to cataract surgery. “Ocular surface dysfunction due to dry eye disease is highly prevalent, and a lot of patients are undiagnosed,” she says. “If we’re not screening for them, we’re missing the opportunity to not only help patients’ eyes feel better but also to help them see better.”