Ocular Surface Frailty Index predicts DED symptom onset after cataract surgery

Noninvasive and low-tech procedures can be used to easily and quickly estimate the Ocular Surface Frailty Index (OSFI), which appears to predict the onset of postoperative dry eye disease (DED) symptoms, according to a recent study.

“This novel tool may allow cataract surgeons to perform a useful preoperative personalized risk assessment,” the authors said.

A total of 405 consecutive patients scheduled for phacoemulsification for age-related cataract were screened for this single-centre, observational, longitudinal study. Analysis was done on 284 eyes of 284 patients without preoperative DED symptoms who underwent uneventful cataract surgery.

The authors developed a tool to evaluate ocular surface frailty. Starting from a preliminary list of 19 potential items, they made the final OSFI—including 10 deficits in ocular surface health, factors potentially able to affect it, or both--through a stepwise approach.

The authors also calculated preoperative OSFI results for each enrolled patient and carried out diagnostic tests for DED at the screening visit and at 1 week, 1 month, and 3 months after surgery. Finally, the ability of OSFI to predict the presence of DED symptoms at 1 month or 3 months after surgery, or both, was evaluated.

OSFI scores among patients ranged from 0 to 0.666, with a median value of 0.200. Seventeen percent of the participants presented with postsurgical ocular surface symptoms.

A small group (19 percent of the asymptomatic patients) with frail ocular surfaces who showed a significantly higher risk of postsurgical DED symptoms onset (50.0 percent vs 9.6 percent; p<0.001, chi square test) was identified using an OSFI cutoff of 0.300.

On logistic regression analysis, OSFI results of ≥0.3—but not age, gender, or any preoperative sign—proved to be predictive of ocular surface symptom onset (odds ratio, 9.45, 95 percent CI, 4.74–18.82). Regression remained significant when performed on 200 bootstrapped samples.