Understanding and Optimizing Ocular Biometry for Cataract Surgery in Dry Eye Disease: A Review

Figures & data

Figure 1. Impact of optical aberrations on the image quality in DED. The image shows the image quality in normal subjects with a stable pre-corneal tear film resulting in a sharp image(a). Image b shows the scatter of light in eyes with dry eye disease (DED) resulting in higher-order aberrations (HOAs) and blurred images.

Figure 2. Algorithm for appropriate management of DED patients presenting in cataract clinics. The algorithm highlights a systematic approach in screening, evaluating, and optimizing dry eye disease (DED) in patients presenting for cataract surgery. It also discusses the recommendations for obtaining reliable ocular biometry in eyes with DED to improve the postoperative outcomes after cataract surgery.

Table 1. Inaccuracies of biometry in DED and impact of treatment.

Study	Effect on biometry in DED	p-Value
Epitropoulos et al.^Citation13	Keratometry difference of >0.5 D in the tear film hyperosmolar group than in the normal group	0.02
Liu et al.^Citation29	The SRI, SAI and magnitude of astigmatism were significantly higher in patients with DED as compared to normal subjects	0.02
	A significantly greater percentage of irregular patterns on topographic maps were noted in DED	<0.005
Kim et al.^Citation23	Mean absolute error in refraction at 1 month after cataract surgery was significantly lower in the pretreatment group as compared to the non-treatment group Significantly lower refractive surprises were noted after cataract surgery in the pretreatment group	0.008 0.024

Table 2. Effect of different topical medications on keratometry and optical aberrations in DED.

Topical medications	Effect on keratometry and optical aberrations	p-Value
Cyclosporine (0.09%)^Citation46	Significant predictive accuracy of corneal power measurement following treatment Mean improvement in HOA by 0.28 ± 0.27 µm	<0.03 <0.0001
Lifitegrast^Citation47	Accuracy of anterior keratometry measurements in predicting postoperative spherical equivalent refractive error improved	<0.04
	Improvement in HOA by 0.16 ± 0.33 µm	<0.001
Rebamipide^Citation48	Reduction in the variability of astigmatisms after treatment with rebamipide (0.13 ± 0.06)	<0.001
Low-viscosity artificial tears^Citation45	Significant variability of >0.5 D was observed in 27.8% up to 5 min.	<0.001
High-viscosity artificial tears^Citation45	Significant variability of >0.5 D was observed in 34.3% of cases up to 5 min.	<0.001

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