Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation

J Cataract Refract Surg. 2018 Sep;44(9):1090-1096. doi: 10.1016/j.jcrs.2018.06.026. Epub 2018 Aug 2.


Purpose: To report the prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation.

Setting: Duke University Eye Center and Weill Cornell Ophthalmology, single-physician practices.

Design: Prospective case series.

Methods: Consecutive patients presenting for cataract surgery evaluation were identified. Patient information including demographics, medical history, slitlamp findings, tear osmolarity, and tear matrix metalloproteinase-9 (MMP-9) levels were recorded. Patients were considered to have ocular surface dysfunction if any of the following outcomes were present: visually significant abnormal corneal surface examination, positive MMP-9 test, or abnormal osmolarity values (>307 mOsm/L or >7 mOsm/L intereye difference). Patient symptoms were recorded using the ocular surface disease index (OSDI) or Symptom Assessment iN Dry Eye questionnaires.

Results: There were 120 patients (69% women), mean age 69.5 years ± 8.4 (SD). Abnormal osmolarity was found in 68 patients (56.7%), and abnormal MMP-9 in 76 patients (63.3%). Clinical findings showed that 47 patients (39.2%) had positive corneal staining on presentation, 9 patients (7.5%) had epithelial basement membrane dystrophy, and 2 patients (1.6%) had Salzmann nodules. Questionnaire data showed 54 (54.0%) of 100 patients reported symptoms suggestive of ocular surface dysfunction. In the asymptomatic group of 46 patients, 39 (85%) had at least 1 abnormal tear test (osmolarity or MMP-9) and 22 (48%) had both tests abnormal. Overall, 96 (80%) of 120 patients had at least 1 abnormal tear test result suggestive of ocular surface dysfunction and 48 patients (40%) had 2 abnormal results.

Conclusions: Objective ocular surface dysfunction findings were common among patients presenting for cataract surgery, yet many presented undiagnosed. Clinicians should be aware of this high prevalence and consider screening with tear testing before surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Basement Membrane / pathology
  • Cataract Extraction / statistics & numerical data*
  • Dry Eye Syndromes / diagnosis
  • Dry Eye Syndromes / epidemiology*
  • Dry Eye Syndromes / metabolism
  • Epithelium, Corneal / pathology
  • Female
  • Humans
  • Male
  • Matrix Metalloproteinase 9 / metabolism*
  • Middle Aged
  • Osmolar Concentration
  • Prevalence
  • Prospective Studies
  • Surveys and Questionnaires
  • Tears / chemistry*
  • Tears / enzymology


  • MMP9 protein, human
  • Matrix Metalloproteinase 9