Prevalence of Dry Eye Disease and Quality of Life Associations in Pre-operative Cataract Patients.
PURPOSE: To evaluate the prevalence of dry eye disease including tear osmolarity, meibomian gland dysfunction (MGD) and quality of life parameters associated with persistent dry eye symptoms prior to cataract surgery.
STUDY DESIGN: A retrospective analysis of thirty-five patients presenting for pre-operative cataract surgery assessment at a single practice was performed.
METHODS: All eyes underwent tear osmolarity testing in addition to screening lower eyelid meibography with grading of meibomian gland dysfunction based on percentage of structurally normal glands, shortened glands, lost glands and early obstructed glands. Patients also completed a dry eye survey which quantifies symptom frequency, symptom severity and vocational severity. Patients were categorized into 3 groups based on dry eye survey scores to a maximum total of 87 points as either mild (1-29), moderate (30-58), or severe (59-87).
RESULTS: The overall mean tear osmolarity for 70 eyes of 35 patients was 308 ± 2.0 mOsms/L. The mean dry eye survey score was 32 ± 2.9. Meibography, expressed as a percentage of total glands in the lower eyelid involved, revealed 49.5 ± 3.3 as structurally normal, 12.4 ± 1.5 obstructed, 19.6 ± 3.0 truncated, 13.3 ± 2.6 atrophic.
In the mild category, the mean tear osmolarity for 32 eyes of 16 patients was 305 ± 4.4 mOsms/L. The mean dry eye survey score was 17 ± 1.9. Meibography revealed 49.4 ± 4.5% as structurally normal. In the moderate category, the mean tear osmolarity for 32 eyes of 16 patients was 309 ± 2.4 mOsms/L. The mean dry eye survey score was 41.1 ± 2.1. Meibography revealed 51.1 ± 5.0% as structurally normal. In the severe category, the mean tear osmolarity for 6 eyes of 3 patients was 313 ± 6.5 mOsms/L. The mean dry eye survey score was 64 ± 2.5. Meibography revealed 41.7 ± 14% as structurally normal.
The mean differences in tear osmolarity between the categories were as follows: mild vs. moderate 4.2 mOsms/L (p = 0.16); mild vs. severe 8.2 mOsms/L (p = 0.15); and moderate vs. severe 4.0 mOsms/L (p = 0.30). The mean differences in meibography as a percentage of normal glands between the categories were as follows: mild vs. moderate 1.7 (p = 0.40); mild vs. severe 7.7 (p = 0.30); and moderate vs. severe 9.4 (p = 0.30).
CONCLUSION: Dry eye disease is prevalent in preoperative cataract patients. Most patients fit in the mild or moderate category based on the dry eye survey scores. Tear osmolarity and meibomian gland dysfunction correlate with symptom severity and may guide the cataract surgeon in pre- and post-operative dry eye treatment planning.

Prevalence of dry eye disease and quality of life associations in pre-operative cataract patients

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