A new study presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting reveals that many patients continue to experience ocular surface issues even a month after cataract surgery, despite following standard postoperative treatment.
The research, conducted at the Cincinnati Eye Institute, involved 71 patients undergoing cataract surgery. Tear film osmolarity, a key marker of dry eye disease, was measured before surgery and again 30 days afterward using the ScoutPro Osmolarity System. Elevated tear osmolarity—defined as ≥ 315 mOsm/L per ASCRS guidelines—indicates a disrupted tear film, which contributes to dry eye.
Before surgery, 44% of patients (31 out of 71) already had elevated osmolarity. Of the 59 patients who returned for the 30-day checkup, 31% of those who had normal osmolarity before surgery developed hyperosmolarity after. Meanwhile, only half of the patients who had high osmolarity before surgery saw improvement—despite being treated with antibiotics, corticosteroids, NSAIDs, and artificial tears.
Dr. Amar Shah, the study’s lead investigator and a cataract and cornea specialist at Mid-Ohio Eye, told HCPLive that hyperosmolarity causes light scatter, which can interfere with vision just as cataracts do. However, unlike a cataract—which creates a constant level of distortion—tear film issues cause fluctuating vision, often changing between blinks or at different times of day. This makes them more difficult to detect during routine eye exams.
Shah said the findings suggest a need for better-targeted treatments. He recommended considering options beyond the usual eye drops, such as preservative-free artificial tears, or prescription medications like cyclosporine and lifitegrast, or even punctal plugs.
“This study shows that our usual drop regimen may not be enough for every patient,” Shah said. “We might need to add more tailored therapies to manage tear osmolarity effectively.”
With more patients opting for premium intraocular lenses and expecting clear, high-quality vision after surgery, Shah emphasized the importance of managing dry eye and ocular surface disease both before and after surgery.
“There’s definitely room to be more proactive in how we address dry eye,” Shah added. “Especially today, where patients have higher expectations and newer lens technologies demand better ocular surface health.”
Shah reported no relevant conflicts of interest.
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