Research shows cataract surgery can lead to the development or worsening of dry eye symptoms, with dry eye being a major complaint in the postoperative period. To help optometrists and ocular surgeons better anticipate iatrogenic dry eye in their patients, Italian researchers performed a single-center, prospective study to build a new clinical tool they call the Ocular Surface Frailty Index (OSFI). They are presenting their findings today at the annual ARVO conference in Vancouver.

The team found that the OSFI can be easily and quickly calculated using noninvasive, low-tech procedures and is predictive of postoperative DED onset, allowing surgeons and comanaging optometrists to perform useful personalized preoperative risk assessments.

The study included 303 eyes of 303 patients scheduled for phacoemulsification for age-related cataract at the Eye Clinic of San Giuseppe Hospital of Milan, none of whom had preoperative DED or other ocular surface diseases. The patients underwent uneventful cataract surgery with posterior chamber monofocal intraocular lens implantation. 

The researchers’ new OSFI includes 20 clinical factors to assess preoperatively; the as-yet-unpublished list of items that comprise the index help uncover any health deficits relevant to dry eye. They calculated preoperative OSFI for each enrolled patient and performed diagnostic tests for DED at the screening visit and one week and one month after surgery. They then evaluated the association between the preoperative OSFI and the onset of DED within one month of surgery.

The team found that the median preoperative OSFI score was 216 and ranged from 0 to 483. They identified three distinct categories: mild frailty (OSFI ranging from 0 to 161), moderate frailty (162 to 322) and severe frailty (over 323). They note that 16.2% of study participants developed DED within one month after surgery, and the rate significantly increased from 10.2% to 38.1% from the lowest to the highest frailty category. They also discovered that OSFI (but not age and gender) was significantly associated with postoperative DED onset.

“This is a great example of precision medicine delivered in a personalized fashion by providing a frailty risk assessment to predict the likelihood of adverse conditions occurring after a surgical procedure,” says Joseph Shovlin, OD, of Northeastern Eye Institute in Scranton, PA.

Villani E, Marelli L, Lucentini S, et al. The Ocular Surface Frailty Index as a predictor of dry eye onset after cataract surgery. ARVO 2019. Abstract 6776-B0300.