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

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.