The Ocular Surface Frailty Index as a Predictor of Ocular Surface Symptoms Onset After Cataract Surgery
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPurpose
The identification of healthy subjects more susceptible to develop post-surgical ocular surface symptoms is still an unmet need. We performed this study to build a new Ocular Surface Frailty Index (OSFI) and to assess its predictive value for dry eye (DED) symptoms onset after cataract surgery.
Design
Single-centre, observational, longitudinal study.
Participants
We screened 405 consecutive patients scheduled for phacoemulsification for age-related cataract. 284 eyes of 284 patients without pre-operative DED symptoms who underwent uneventful cataract surgery were included in the analysis.
Methods
Borrowing a concept from geriatric surgery and following a previously validated procedure, we built a tool to assess ocular surface frailty. Starting from a preliminary list of 19 potential items, the final OSFI, including 10 “deficits in ocular surface health and/or factors potentially able to affect it”, was developed by a stepwise approach. Pre-operative OSFI was calculated for each enrolled patient and diagnostic tests for DED were performed (following the TFOS DEWS II recommendations) at the screening visit and 1 week (V1), 1 month (V2), and 3 months (V3) after surgery. We evaluated OSFI predictivity for the presence of DED symptoms at V2 AND/OR V3.
Main Outcome Measures
The rate of ocular surface symptoms at V2 AND/OR V3.
Results
Our patients’ OSFI score ranged from 0 to 0.666, with a median value of 0.200 (0.133-0.266). The percentage of patients with post-surgical ocular surface symptoms was 17%. Using an OSFI cut-off of 0.300, we identified a small group (19% of the asymptomatic subjects) of patients with frail ocular surfaces, who had a significantly higher risk to develop post-surgical DED symptoms (50.0% vs 9.6%; P<0.001, χ2 test). Logistic regression analysis showed that OSFI≥0.3 (but not age, gender or any pre-operative sign) was a good predictor of ocular surface symptoms onset (odds ratio (OR) =9.45; 95%CI (4.74-18.82). Regression was still significant when performed on 200 bootstrapped samples.
Conclusions
The OSFI can be easily and quickly calculated using non-invasive and low-tech procedures and it showed to be predictive of post-operative ocular surface symptoms onset. This novel tool might allow cataract surgeons to perform a useful pre-operative personalized risk assessment.
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Additional Info
Disclosure statements are available on the authors' profiles:
I like the term "Ocular Surface Frailty Index" (OSFI), and the questionnaire developed may be useful in standardizing factors that might predispose the patient to have ocular surface symptoms after cataract surgery, but who have not previously been diagnosed as having dry eye disease. It may be useful in counseling patients, or in some cases pretreating the ocular surface to make it more resilient to the after-effects of cataract surgery. As the authors note, since this is the first report of the OSFI, the results need to be replicated by other studies.
Successful cataract surgery can be negatively impacted by unintended consequences such as dry eye disease (DED). For those who have preexisting dry eye disease, that treatment is undoubtedly addressed. However, it is those patients who are asymptomatic and end up with dry eye disease after cataract surgery who also need to be considered. If there were a way to predict those patients who might experience dry eye symptoms so that appropriate treatment either before or after cataract surgery could be initiated to minimize the impact of DED, thereby maximizing quality of life post surgery, that would be welcomed by both doctor and patient. In this study, the issue of frailty is a consideration which might help practitioners to predict and address dry eye disease in these patients. To those ends, the authors developed an Ocular Surface Frailty Index (OSFI). Notably, it is not chronological age but decreased functional capacity which this study attributes to the impact on outcomes. Although the authors point out that their selection of components was arbitrary and that it can be time-consuming, a key take-home message is that, if this index is validated by more study, it can improve doctor–patient communications with respect to patient expectations and management of dry eye disease post surgery.