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Comorbidity Associations with Ocular Pain after Cataract Surgery: Overall and Sex-Stratified Analysis
Eliot N Haddad1,2, Radhika S Amin2,3, Anukriti Sharma4
1Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
Purpose:
Ocular pain persisting at least three months after cataract surgery is an underrecognized complication suggested to be associated with systemic comorbidities. No prior study has systematically examined whether these comorbidity associations differ by sex. This study aimed to characterize systemic comorbidities associated with ocular pain after cataract surgery and to assess whether these associations are modified by biological sex.
Design:
A retrospective, propensity score-matched case-control study using de-identified health records from Epic Cosmos.
Methods:
Adults who underwent cataract surgery were identified via current procedural terminology codes, and cases were defined as patients with ocular pain, based on International Classification of Diseases- Tenth Revision (ICD-10) encounter diagnoses, ≥3 months postoperatively. Controls were cataract surgery patients without ocular pain ICD-10 encounter diagnoses. Comorbidities were grouped into clinically relevant categories and analyzed using 2 × 2 contingency tables with false discover rate correction. Sex-stratified analyses with formal sex-interaction tests were performed to identify effect modification.
Main Outcome Measure:
Odds of an associated comorbidity diagnosis in cases compared to controls.
Results:
Among 38,075 matched case-control pairs (66.2% female), 31 of 36 individual comorbidities were significant after FDR correction. The strongest associations were temporomandibular joint disorder (OR 1.96, 95% CI 1.80-2.13) and post-traumatic stress disorder (OR 1.70, CI 1.53-1.89). Seven of eight comorbidity categories were significant, led by centralized/nociplastic pain (OR 1.55, CI 1.50-1.60), non-inflammatory gastrointestinal (OR 1.46, CI 1.42-1.50), and psychiatric (OR 1.39, CI 1.35-1.43). Adiposity showed no association (OR 1.00, CI 0.97-1.03). All seven comorbidity categories remained significant in both sexes. Thyroid disease was the only significant sex interaction, stronger in males (OR 1.36, CI 1.26-1.46) than females (OR 1.15, CI 1.11-1.20).
Conclusion:
Ocular pain after cataract surgery was associated with a broad burden of systemic comorbidities, most strongly with centralized/nociplastic pain, gastrointestinal, and psychiatric conditions. This comorbidity profile was largely shared between the sexes, with thyroid disease the sole exception. These findings can be used to inform counseling practices for patients presenting to clinic for preoperative evaluation for cataract surgery. Further research on the impact of such counseling and the optimal approach is needed.
