Prevalence of Dry Eye Disease Among Individuals Scheduled for Cataract Surgery in a Norwegian Cataract Clinic

Abstract

Purpose

To determine the prevalence of dry eye disease (DED) in patients scheduled for cataract surgery in a Norwegian eye clinic.

Patients and Methods

218 patients scheduled for cataract surgery were examined for DED in one randomly selected eye and questioned regarding symptoms and risk factors. Patients were diagnosed with DED if they fulfilled the DEWS II criteria with symptom score >12/100 with Ocular Surface Disease Index (OSDI) questionnaire, and the presence of any of the three signs: tear osmolarity >307 mOsm/L in either eye or a difference in osmolarity between the two eyes of >8 mOsm/L, corneal fluorescein staining (CSF) ≥ grade 2 and non-invasive tear film breakup time (NIKBUT) of <10 seconds. Additional tests were the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear meniscus height (TMH), Schirmer 1, tear film thickness (TFT), corneal sensitivity and meibography (meiboscore). Dry eye test outcomes were correlated with risk factors for DED.

Results

The prevalence of DED was 55.5% according to the DEWS II criteria. The abnormal osmolarity percentage was 66.5, while 29.8% had shortened NIKBUT and 19.7% exhibited CFS ≥2. 57% had Schirmer 1 ≤ 10 mm/5 min, and 81.1% had a meiboscore of ≥1. 71.2% of subjects scored positive for DED symptoms using the OSDI questionnaire and 69.3% using SPEED. Logistic regression analysis showed that higher age correlated with a lower OSDI symptom score, reduced corneal sensitivity and increased meibomian gland atrophy. Female sex was associated with higher odds of having DED, abnormal NIKBUT and abnormal CFS. Ocular tests for DED did not correlate with OSDI symptom scores when assessed with Spearman`s rank analysis.

Conclusion

The prevalence of DED in an elderly Norwegian population scheduled for cataract surgery is high and associated with female sex. There was a lack of correlation between signs and symptoms of DED.

Keywords:

• dry eye disease
• cataract surgery
• corneal fluorescein staining
• ocular surface
• osmolarity
• non-invasive keratograph tear break up time
• NIKBUT
• meibomian gland dysfunction

Ethical Statement

The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study was approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref. 2020/64847). All participants have provided written informed consent to participate in this study.

Acknowledgments

The authors wish to thank Bjørn Gjerdrum, PhD, Ifocus Eye Clinic, Haugesund, Norway for help with statistics and writing advice.

Disclosure

Dr Per Graae Jensen reports grants from The Research Council of Norway, during the conduct of the study. Dr Morten Gundersen reports grants from Norwegian research council, during the conduct of the study. Dr Rick Potvin reports personal fees from Alcon, personal fees from Carl Zeiss Meditec, outside the submitted work. Dr Øygunn A Utheim reports grants from The Research Council of Norway, during the conduct of the study; received artificial tear fluid from Thea Pharma, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was supported by The Research Council of Norway (project nr. 306649).