The Ocular Surface Frailty Index as a predictor of ocular surface symptoms onset after cataract surgery

Abstract Purpose The identification of healthy subjects more susceptible to develop post-surgical ocular surface symptoms is still an unmet need. We performed this study to build a new Ocular Surface Frailty Index (OSFI) and to assess its predictive value for dry eye (DED) symptoms onset after cataract surgery. Design Single-centre, observational, longitudinal study. Participants We screened 405 consecutive patients scheduled for phacoemulsification for age-related cataract. 284 eyes of 284 patients without pre-operative DED symptoms who underwent uneventful cataract surgery were included in the analysis. Methods Borrowing a concept from geriatric surgery and following a previously validated procedure, we built a tool to assess ocular surface frailty. Starting from a preliminary list of 19 potential items, the final OSFI, including 10 “deficits in ocular surface health and/or factors potentially able to affect it”, was developed by a stepwise approach. Pre-operative OSFI was calculated for each enrolled patient and diagnostic tests for DED were performed (following the TFOS DEWS II recommendations) at the screening visit and 1 week (V1), 1 month (V2), and 3 months (V3) after surgery. We evaluated OSFI predictivity for the presence of DED symptoms at V2 AND/OR V3. Main Outcome Measures The rate of ocular surface symptoms at V2 AND/OR V3. Results Our patients’ OSFI score ranged from 0 to 0.666, with a median value of 0.200 (0.133-0.266). The percentage of patients with post-surgical ocular surface symptoms was 17%. Using an OSFI cut-off of 0.300, we identified a small group (19% of the asymptomatic subjects) of patients with frail ocular surfaces, who had a significantly higher risk to develop post-surgical DED symptoms (50.0% vs 9.6%; P Conclusions The OSFI can be easily and quickly calculated using non-invasive and low-tech procedures and it showed to be predictive of post-operative ocular surface symptoms onset. This novel tool might allow cataract surgeons to perform a useful pre-operative personalized risk assessment.