Wednesday, March 7, 2018

Abstract: Is cataract surgery the old-but-new LASIK, as regards dry eye?

I think this is the most dramatically worded study I've seen on cataract surgery and dry eye. Way to go Dr Galor! It's definitely making me want to go back and re-read some others to remind myself what the numbers were.

Nothing in this surprises me particularly, but it's really something to see it in print. I'm very pleased to see they used a survey that includes the word burning - that's one of the most common and crippling symptoms for those with severe symptoms, but it is omitted way too often in symptom surveys, as  TFOS DEWS II epidemiology report points out. And I love that the participants are almost all men, who are not the primary dry eye demographic, as it makes the results that much more interesting.

Can't wait to see the complete study. Cornea is still on my Dear Santa list.

  • 95% of participants were men
  • 1/3 of patients have persistent postsurgical pain
  • Prevalence compared with refractive surgery, e.g. LASIK
Cornea. 2017 Dec 7
Epidemiology of Persistent Dry Eye-Like Symptoms After Cataract Surgery.
Iglesias E1, Sajnani R2, Levitt RC3,4,5, Sarantopoulos CD3, Galor A1,6.
To evaluate the frequency and risk factors for persistent postsurgical pain (PPP) after cataract surgery, defined as mild or greater dry eye (DE)-like symptoms 6 months after surgery. 
This single-center study included 86 individuals who underwent cataract surgery between June and October 2016 and had DE symptom information available 6 months after surgery. Patients were divided into 2 groups: controls were defined as those without DE symptoms 6 months after surgery (defined by a Dry Eye Questionnaire 5 (DEQ5) score 
Mean age of the study population was 71 ± 8.6 years; 95% (n = 82) were men. DE-like symptoms were reported in 32% (n = 27) of individuals 6 months after cataract surgery; 10% (n = 8) reported severe symptoms (DEQ5 ≥12). Patients with DE-like symptoms after cataract extraction also had higher ocular pain scores and specific ocular complaints (ocular burning, sensitivity to wind and light) compared with controls with no symptoms. A diagnosis of nonocular pain increased the risk of DE-like symptoms after cataract surgery (odds ratio 4.4, 95% confidence interval 1.58-12.1, P = 0.005). 
Mild or greater PPP occurred in approximately 1/3 of individuals after cataract surgery. Prevalence of severe PPP is in line with that of refractive surgery, dental implants, and genitourinary procedures.


boatman222345 said...

Rebecca, once again you have shed some much needed light on one of mecdicines shadowy areas. Thanks! No pun intended but reading this article on post-op dry eye symptoms after cateract surgery would normally have left me in a state somewhere between laughter and tears. Alas as an unhappy member of the 30% experiencing severe dry eye symptoms after cateract surgery I'm a bit short on tears. And, for that matter, on laughter as well! Prior to having 5 cateract surgeries at age 62 (no I don't have 5 eyes, just bad luck!) I never had any problem with dry eyes. Given that I am both a professional boat captain and wildife/nature photographer spending countless hours each year in windy/sunny conditions my guess is that prior to cateract surgery and multiple "clean up" surgerical proceedures I probably had pretty impressive tear production. Causal links can be pretty dificult to establish in medicine but I've long suspected that my severe dry eye problems were related to cateract surgery given that they began around a year or so after the surgery. I've mentioned this a time or two to my ophthalmological surgeon but he's no a fan of the theory. Of course he has somewhat of a vested interest in resisting the cause/effect relationship given that he makes his living removing cateracts.

debdeb said...

I have had a very similar wxperience that began within weeks of my cataract surgery in May and June 2013. Only single procedures on OS and OD respectively. Un relenting worsening and progession since then. Have tried punctal plugs, LipiFlow, MGD probing, numerous OTC eye drops, Restasus, Xiidra, Autolgous Serum Tears, etc, etc all to no avail. Have initial consultfor Prose scleral lens at Boston Sight next week. My mother, who lived to age 93 had macular degeneration BUT also a chronic xs “tearing problem”. I suspect she had DED which was never diagnosed back then. Perhaps there is/was a genetic pre-disposition. My experience also has been that operating surgeon soft pedaled any assiciation and I believe was more ir less un informed. More than one individual, including Dr. Hamrah at Tufts New England Eye Center have indicated that there is a known connection w cataract surgery but that this has been hushed up. Pretty discouraging from a “transparency” perspective.