Work

Association of Cataract History with Dry Eye Disease Signs and Symptoms in the DREAM Study

Year: 2025

Type: article

Abstract: Background: Dry eye disease (DED) and cataracts are highly prevalent ocular conditions, particularly among older adults. However, the relationship between cataracts, cataract surgery, and DED severity remains poorly understood. This study aimed to assess the associations between cataract history and DED signs and symptoms in participants with moderate-to-severe DED. Methods: This is a secondary analysis of data from a double-blind randomized control trial of participants (n = 535) with moderate-to-severe DED in the DREAM Study. At baseline, cataract history and patient characteristics were collected; DED signs and symptoms were assessed at baseline, 6 and 12 months. Cataract history was classified as: no history of cataracts, ongoing cataracts (clinically diagnosed cataracts without surgical intervention), or history of cataract surgery > 6 months prior to enrollment. Associations between cataract history and DED signs and symptoms were evaluated by univariate and multivariate regression analysis. Results: Among 1070 eyes from 535 participants, 646 eyes (60%) had no history of cataracts, 244 eyes (23%) had ongoing cataracts, and 180 eyes (17%) had a history of cataract surgery > 6 months prior. On univariate analysis of the combined data from baseline, 6 and 12 months, corneal staining scores were significantly worse in eyes with a history of cataract surgery than eyes with ongoing cataracts and eyes without history of cataracts (4.08 vs 3.63 vs 3.14; P =0.005). However, the difference became non-significant after adjustment by age alone (3.62 vs 3.38 vs 3.37, P =0.71) or by factors associated with DED severity ( P =0.72). In multivariate analysis, meibomian gland dysfunction was significantly worse in eyes with no history of cataracts than in eyes with ongoing cataracts or with history of cataract surgery (3.1 vs 2.7 vs 2.6; P =0.02). Conclusion: Cataract surgery was not independently associated with worse DED symptoms and signs. This indicates that exacerbations of DED severity following cataract surgery are either age-related or transient in patients with moderate-to-severe DED. Plain Language Summary: Many older adults suffer from both dry eyes and cataracts, but doctors have not been sure if cataract surgery makes dry eye problems worse in the long term. Our research team studied 535 people with moderate-to-severe dry eye disease to find out. We compared dry eye symptoms and clinical signs among people with no cataracts, ongoing cataracts, and those who had undergone cataract surgery at least six months before joining our study. Our findings challenge the common belief that cataract surgery worsens dry eye. While patients who had cataract surgery initially appeared to have more severe dry eye signs, this difference disappeared when we accounted for their older age and other health factors. Interestingly, people who had undergone cataract surgery showed healthier oil-producing glands in their eyelids compared to those without cataracts. This might be because they were more likely to use anti-inflammatory eye drops that could help these glands recover. These results are reassuring for people with dry eyes who need cataract surgery. Any worsening of dry eye symptoms after surgery is likely temporary rather than permanent. This information helps eye doctors better counsel patients and manages their expectations regarding how cataract surgery might affect their pre-existing dry eye condition. Keywords: DED, dry eye, cataract, DREAM

Source: Clinical ophthalmology

DOI: 10.2147/opth.s541618

Authors: Aaron Zhao, Jocelyn He, Penny Asbell, Vatinee Bunya, Gui-Shuang Ying

Institutions: University of Pennsylvania, University of Memphis

Language: English

Topic: Ocular Surface and Contact Lens

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,320