The reasons why some otherwise healthy patients develop ocular surface issues post-cataract surgery can be challenging to predict. A team of researchers from Italy may have broken this barrier by creating a new tool, “The Ocular Surface Frailty Index,” they say can help determine which patients may be predisposed to dry eye symptoms and ocular surface issues after cataract removal.

The single-center study screened 405 patients scheduled for phacoemulsification for age-related cataract. Out of these, the investigation enrolled 284 eyes of 284 patients who didn’t have preoperative dry eye symptoms and underwent uneventful cataract surgery.

The researchers adopted a similar concept previously used in geriatric surgery to assess ocular surface vulnerability. Their index included these ten risk/contributing factors:

  • Connective tissue diseases
  • Thyroid malfunction
  • Psychiatric conditions
  • Computer use
  • Ocular allergy
  • History of refractive surgery
  • Topical drugs
  • Tear break-up time
  • Meibomian glands expressibility
  • Lid parallel conjunctival folds

Participants completed a questionnaire regarding their medical history, and diagnostic tests for dry eye were performed at the screening visit and again at one week, one month and three months after surgery. Clinical testing included tear film osmolarity, fluorescein tear film break-up time, ocular surface staining, meibomian gland expressibility, lid parallel conjunctival folds and Schirmer testing. All procedures were performed following the recommendations of the Tear Film and Ocular Surface Society Dry Eye Workshop II.

The Ocular Surface Frailty Index was based on a count of “deficits in ocular surface health and/or factors potentially able to affect it.” Each of the ten variables in the index received a score of zero to one.

The main outcome was the onset of cataract surgery-related ocular surface symptoms, and the secondary outcome was the presence of dry eye disease.

The patients’ index scores ranged from 0 to 0.666, with an approximate cumulative score of 0.200. The percentage of patients with post-surgical ocular surface symptoms was 17%.

Using an index cut-off of 0.300, researchers identified a small group (19% of the asymptomatic subjects) of patients with frail ocular surfaces who had a significantly higher risk of developing post-surgical dry eye symptoms (50% vs. 9.6%). Further analysis showed index scores that were 0.300 or greater were a good predictor of the possibility of ocular surface symptoms. The study noted age, gender and preoperative signs didn’t seem to factor into whether patients would develop ocular surface issues.  

The Ocular Surface Frailty Index can be easily and quickly calculated using noninvasive and low-tech procedures, the researchers said.

“This novel tool might allow cataract surgeons to perform a useful preoperative personalized risk assessment,”the researchers wrote in the paper.

Marelli L, Bonsignore F, Lucentini S, et al. The ocular surface frailty index as a predictor of ocular surface symptoms onset after cataract surgery. Ophthalmology. December 27, 2019. [Epub ahead of print].