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The Ocular Surface Frailty Index as a Predictor of Ocular Surface Symptom Onset after Cataract Surgery
Edoardo Villani1, Luca Marelli1, Francesco Bonsignore1
1Department of Clinical Sciences and Community Health, University of Milan, Eye Clinic San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.
Purpose:
The identification of healthy persons more susceptible to dry eye (DED) symptoms developing after surgery remains an unmet need. We performed this study to build a new Ocular Surface Frailty Index (OSFI) and assess its predictive value for DED symptom onset after cataract surgery.
Design:
Single-center, observational, longitudinal study.
Participants:
We screened 405 consecutive patients scheduled for phacoemulsification for age-related cataract. Two hundred eighty-four eyes of 284 patients without preoperative DED symptoms who underwent uneventful cataract surgery were included in the analysis.
Methods:
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, factors potentially able to affect it, or both, was developed by a stepwise approach. Preoperative OSFI results were calculated for each enrolled patient and diagnostic tests for DED were performed at the screening visit and 1 week, 1 month, and 3 months after surgery. We evaluated the ability of OSFI to predict the presence of DED symptoms at 1 month or 3 months after surgery, or both.
Main Outcome Measures:
The rate of ocular surface symptoms at 1 month or 3 months after surgery, or both.
Results:
Our patients' OSFI scores ranged from 0 to 0.666, with a median value of 0.200. The percentage of patients with postsurgical ocular surface symptoms was 17%. Using an OSFI cutoff of 0.300, we identified a small group (19% of the asymptomatic patients) with frail ocular surfaces who showed a significantly higher risk of postsurgical DED symptoms develop (50.0% vs. 9.6%; P < 0.001, chi-square test). Logistic regression analysis showed that OSFI results of 0.3 or more (but not age, gender, or any preoperative sign) was a good predictor of ocular surface symptom onset (odds ratio, 9.45; 95% confidence interval, 4.74-18.82). Regression remained significant when performed on 200 bootstrapped samples.
Conclusions:
The OSFI can be calculated easily and quickly using noninvasive and low-tech procedures, and it proved to be predictive of postoperative DED symptoms onset. This novel tool may allow cataract surgeons to perform a useful preoperative personalized risk assessment.
