• Cataract/Anterior Segment, Cornea/External Disease

    Review of: The Ocular Surface Frailty Index as a Predictor of Ocular Surface Symptom Onset after Cataract Surgery

    Villani E, Marelli L, Bonsignore F, et al. Ophthalmology, July 2020

    Researchers developed and tested a new ocular surface frailty index (OSFI) for predicting dry eye symptoms after uneventful cataract surgery.

    Study design

    This is a single-center, longitudinal, observational study of 284 eyes without preoperative ocular surface disease symptoms that underwent cataract surgery. Ocular surface data was analyzed via the OSFI, a 10-point tool developed by the authors that included connective tissue disease, thyroid malfunction, psychiatric conditions, computer use, ocular allergy, history of refractive surgery, topical drugs, tear break up time with fluorescein, meibomian gland expression and lid parallel conjunctival folds. The main outcome was presence of ocular surface disease symptoms at postoperative months 1 and 3.


    The total percentage of patients with ocular surface symptoms after cataract surgery was 17%. Patients with a frail ocular surface risk preoperatively (OSFI >0.3) had a statistically significant postoperative risk of symptoms compared with patients with a robust ocular surface (50.0% vs. 9.6%; P < 0.001). Interestingly, univariate logistic regression showed that age and gender had no association with dry eye disease symptom onset after cataract surgery.


    The selection of components for the OSFI was determined by the authors and could be further refined as we better understand this complex disease. Also, the short follow-up stands out as a study limitation because it may be important to know the expected timeline for symptom resolution in this population. The number of subjects that were asymptomatic for the disease but showed disease signs (e.g., hyperosmolarity, decreased TBUT, corneal staining) was significantly high (72.5%), which further validates the need for examination of the ocular surface in all patients requiring cataract surgery. It suggests that objective measures of ocular surface disease may be more useful than subjective symptoms questionnaires for identifying this at-risk population.

    Clinical significance

    Cataract surgery patients have extremely high expectations of both visual improvement and comfort after cataract surgery but ocular surface disease symptoms may affect patients’ perception of outcome. It is well known that the ocular surface is an important factor for refractive outcomes after surgery, and limiting the development of symptoms in asymptomatic patients can help improve both postoperative vision and patient satisfaction.