Dry Eye Disease as a Cause of Refractive Errors After Cataract Surgery – A Systematic Review

Figures & data

Table 1 Baseline Characteristics for Enrolled Patients in Trials Evaluating Dry Eye Treatment on Refractive Errors

Article	Doga et al^Citation16	Hovanesian et al^Citation17	Kim et al^Citation18	Hovanesian et al^Citation19
Treatment of DED	Dexamethasone 0.1%	Cyclosporin A 0.09%	Loteprednol 0.5% + Cyclosporin A 0.05%	Lifitegrast 5%
Duration of therapy	2 weeks	4 weeks	2 weeks	4 weeks
Patients enrolled	24	75	105	103
Patients examined	17	64	53	83
Control group	None	None	52	None
Average age	54.7 ± 3.6	70.5 ± 7.4	67.9 ± 11.8	71.3 ± 11.6
Sex (male / female)	10 / 14	30 / 34	18/ 35	49 / 54

Table 2 Effect of Dry Eye Treatment on Refractive Errors After Cataract Surgery

Article	Doga et al^Citation16			Hovanesian et al – CsA^Citation17			Kim et al*^Citation18			Hovanesian et al – Lifitegrast^Citation19
	Pre-t.	Postt.	P value	Pre-t.	Postt.	P value	Pre-t.	Postt.	P value	Pre-t.	Postt.	P value
MAE				0.39 ± 0.30 D	0.33 ± 0.25 D	<0.03	0.38 ± 0.34 D	0.24 ± 0.19 D	0.008
± 0.25		41.2%		41%	47%	< 0.05	36.6%	58.5%	0.02	47%	50%	< 0.04
± 0.50		76.5%		72%	73%	< 0.31	73.2%	90.50%	0.154	71%	79%	< 0.04
± 0.75				88%	95%	< 0.03	85%	98%		81%	91%	< 0.04
± 1.0		100%

Note: *By Barrett Universal II.

Abbreviations: Pre-t, pre-treatment; Postt, posttreatment; MAE, mean absolute error.

Table 3 Diagnostic Tests for Dry Eye Disease

Article	Doga et al^Citation16	Hovanesian et al – CsA^Citation17	Kim et al^Citation18	Hovanesian et al – Lifitegrast^Citation19
Signs	OSDI	SPEED	None	SPEED
Symptoms	Schirmer test Corneal staining (Oxford) TBUT	Conjunctival hyperemia (Schulze) Corneal staining (Oxford) TBUT	Schirmer test Corneal staining (Oxford) TBUT	Conjunctival hyperemia (Schulze) Corneal staining (Oxford) TBUT

Abbreviations: CsA, cyclosporin A; OSDI, Ocular Surface Disease Index; SPEED, standard patient evaluation of eye dryness; TBUT, tear break – up time.

Table 4 Proposed Standardized Methodology in Postoperative Refractive Studies According to Hoffer and Savini

Article	Hoffer and Savini^Citation45	Doga et al^Citation16	Hovanesian et al – CsA^Citation17	Kim et al^Citation18	Hovanesian et al – Lifitegrast^Citation19
Visual acuity	0.5 or better	0.33 ± 0.21	No information	No information	No information
Bilateral eyes	1 eye for each patient	1 eye for each patient	1 eye for each patient	1 eye for each patient	1 eye for each patient
Alpha= 0.05	Significance level (α) 0.05	No information	No information	Alpha= 0.05	Alpha= 0.05; calculated before examination
Demographics	Age, gender, ethnicity	Age, gender	Age, gender	Age, gender	Age, gender
Constant optimization	Minimum 100 eyes, leading to a zero mean PE in the analyzed sample	No information	No information	Performed (500 eyes)	No information
Formulas	Chosen by a surgeon	No information	Barrett Universal II	SRK/T and Barrett Universal II	Chosen by a surgeon
Refraction – time after surgery	2 weeks- 1 month	1 month	Approximately 1 month	1 month	28 days
Refraction - distance	6m	No information	No information	No information	No information
Correction	The best spherical equivalent	Yes	Yes	Yes	Yes
Analysis of the PE	PE with SD, MedAE, MAE, the percentage of eyes with an absolute PE within ±0.25 D, ±0.50 D, ±0.75 D and ±1.00 D	The percentage of eyes with an absolute PE within ±0.25 D, ±0.50 D and ±1.00 D	MAE, The percentage of eyes with an absolute PE within ±0.25 D, ±0.50 D and ±0.75 D	ME, MAE The percentage of eyes with an absolute PE within ±0.25 D, ±0.50 D and ±0.75 D, refractive surprises ≥ 0.75 D	The percentage of eyes with an absolute PE within ±0.25 D, ±0.50 D and ±0.75 D

Abbreviations: CsA, cyclosporin A; PE, prediction error; SD, standard deviation; MedAE, median absolute error; MAE, mean absolute error; ME, mean error.

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Hovanesian JA, Berdy GJ, Epitropoulos A, Holladay JT. Effect of cyclosporine 0.09% treatment on accuracy of preoperative biometry and higher order aberrations in dry eye patients undergoing cataract surgery. Clin Ophthalmol Auckl NZ. 2021;15:3679–3686. doi:10.2147/OPTH.S325659

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Kim J, Kim MK, Ha Y, Paik HJ, Kim DH. Improved accuracy of intraocular lens power calculation by preoperative management of dry eye disease. BMC Ophthalmol. 2021;21:364. doi:10.1186/s12886-021-02129-5

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Hovanesian J, Epitropoulos A, Donnenfeld ED, Holladay JT. The Effect of lifitegrast on refractive accuracy and symptoms in dry eye patients undergoing cataract surgery. Clin Ophthalmol Auckl NZ. 2020;14:2709–2716. doi:10.2147/OPTH.S264520

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Hoffer KJ, Savini G. Update on intraocular lens power calculation study protocols: the better way to design and report clinical trials. Ophthalmology. 2021;128(11):e115–e120. doi:10.1016/j.ophtha.2020.07.005

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