Health care utilization, prevalence, and risk factors of dry eyes after cataract surgery

Saffire H Krance; Amin Hatamnejad; Rutmila Uddin; Sohel Somani; Eric Tam; Fahmeeda Murtaza; Hannah H Chiu

doi:10.1016/j.jcjo.2024.08.011

Health care utilization, prevalence, and risk factors of dry eyes after cataract surgery

Can J Ophthalmol. 2024 Sep 5:S0008-4182(24)00257-6. doi: 10.1016/j.jcjo.2024.08.011. Online ahead of print.

Authors

Saffire H Krance¹, Amin Hatamnejad², Rutmila Uddin³, Sohel Somani⁴, Eric Tam⁴, Fahmeeda Murtaza⁵, Hannah H Chiu⁶

Affiliations

¹ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
² Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³ William Osler Health System, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
⁴ William Osler Health System, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Uptown Eye Specialists, Concord, ON, Canada.
⁵ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; William Osler Health System, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Uptown Eye Specialists, Concord, ON, Canada. Electronic address: [email protected].

PMID: 39245292
DOI: 10.1016/j.jcjo.2024.08.011

Abstract

Objective: To quantify post-cataract surgery health care utilization caused by dry eye symptoms (DES) and identify preoperative risk factors and mediators of postoperative DES.

Setting: An outpatient surgical centre in Toronto, Canada.

Design: Retrospective cohort study.

Participants: Included patients had cataract surgery between April 2019 and January 2020, completed a preoperative Dry Eye Questionnaire 5 (DEQ5), and were over age 18.

Methods: Data collected included DES risk factors, prophylaxis, and intraoperative and postoperative details. DES health care utilization and prevalence were reported as percentages. Risk of DES follow-up with DES prophylaxis use, and within each DEQ5 severity group, were analyzed with χ²-square test of independence and odds ratios. Binomial logistic regression assessed for significance of multiple preoperative and intraoperative risk factors, controlling for one another.

Results: Of 1074 patients (46% male, mean age: 71, mean DEQ5: 5.12), 18.1% had at least one nonroutine postoperative appointment due to DES. Patients with moderate/severe DEQ5 scores were 1.843 times likelier to have postoperative DES concerns than those with no/mild scores (CI = 1.307-2.599). Preoperative DES prophylaxis did not reduce DES risk in any severity group. Higher DEQ5 score, female sex, bilateral sequential surgeries, and femtosecond laser-assisted cataract surgery had higher likelihood of postoperative DES (B = 0.054; p < 0.001; B = -0.351; p = 0.037; B = 0.695; p = 0.003; B = 0.491; p = 0.003, respectively).

Conclusion: Nearly 1 in 5 patients had DES postcataract surgery, with 1 in 12 requiring one or more nonroutine follow-ups for DES, suggesting substantial health care burden. Current standard preoperative DES treatment may not reduce postoperative DES, and further studies are needed to elucidate why.