According to published research, as many as 77% of patients with cataracts present with common signs of dry eye disease (DED) prior to surgery. These signs include corneal staining, short tear breakup time, and hyperosmolarity, among others. Unmanaged DED can alter surgical plans and, as a result, postoperative outcomes. Experts believe that preoperative DED management is especially important to successful outcomes with the implantation of premium intraocular lens (IOLs).

By analyzing real-world data from the American Academy of Ophthalmology (AAO) IRIS Registry, clinicians can gain important insights into the prevalence of DED diagnosis and treatment as well as DED treatment patterns in patients receiving premium IOLs. “The IRIS Registry is a valuable resource for mining massive amounts of big data,” explains Christopher E. Starr, MD, FACS, from Weill Cornell Medicine. “While many smaller studies have shown a high prevalence of DED and ocular surface disease (OSD) in the older cataract surgical population, the IRIS database is important because it provides the first ‘big data’ registry to study the prevalence of DED in this population.”

New Data

At the 2020 AAO Annual Meeting, Dr. Starr presented data in which the IRIS Registry was used to determine the prevalence of preoperative DED diagnosis and treatment in the United States, and the association between treatment and receiving advanced technology IOLs. The study population included patients aged 45 years and older with an IOL implantation procedure that was coded between January 1, 2016 and March 30, 2018. The IOL brand and type were recorded, and participants had 2 or more visits within 180 days of the IOL implantation procedure. Patients in the study had a DED diagnosis within 1 year prior to their date of IOL implantation.

“While there are inherent limitations in studies of this nature, a major advantage is the IRIS Registry included almost 90,000 subjects that met the inclusion criteria,” Dr. Starr says. “This is magnitudes larger than any other study on DED in cataract surgical patients.” The average age of patients included in the analysis was 70.3 years, and the majority were female (68.2%) and white (83.4%).

“Our study found that the overall prevalence of DED was about 30%, and only 3% of those patients received DED treatment within 3 months prior to surgery,” says Dr. Starr. The majority of patients—86.3%—who receiving DED treatment before surgery received topical immunomodulators whereas 17.7% received treatments coded as medical procedures. The most common coded procedure was closure of the lacrimal punctum with a plug (10.2%).

“Another key finding was that patients receiving premium IOLs were more likely to be treated for DED, especially in those receiving multifocal IOLs,” Dr. Starr says. Almost two-thirds of the eyes treated for DED received premium IOLs, and eyes receiving extended depth of focus (EDOF) IOLs had the highest percentage of DED-treated eyes, with a rate of approximately 5.0%.

Key Takeaways

“The key takeaway from our study is that DED and OSD are very common in preoperative cataract surgery patients,” says Dr. Starr. “In fact, the incidence is likely higher than the 30% rate were observed in our study. These conditions have the potential to cause adverse consequences on visual outcomes and patient satisfaction if they are not addressed adequately prior to surgery. Logically, it makes sense that patients receiving premium IOLs were more likely to receive treatment for DED prior to surgery. However, the overall rates of treatment, even in this premium subgroup, was still lower than expected.”