PURPOSE: To study the association between hyperosmolarity and ocular light scatter in a cataract surgery population.

METHODS: In a prospective, observational study, contiguous 20 second ocular scatter index (OSI) scans were recorded in hyperosmolar (≥320 mOsm/L) and normal subjects (<308 mosm l with cataract nuclear opacity 3. osi was measured at screening baseline and 90 days following surgery. along with symptoms of ocular surface disease slit lamp examination included corneal staining 03 tear film breakup time tbut and evaluation of meibomian gland disease mgd. an additional cohort of hyperosmolar subjects were measured for osi at screening baseline and 5 10 15 and 30 minutes following instillation of 0.18 sodium hyaluronate ha.>

RESULTS: Thirty-one eyes of 31 patients were included in the analysis. In the group with cataract nuclear opacity ≥3 (n=21), there was a significant difference in postoperative OSI variation when comparing patients with or without hyperosmolarity post-surgery (0.65±0.30 [n=11] vs 0.33±0.11 [n=10], p=0.005), with variations in the order of 2–3 OSI in hyperosmolar eyes. These changes were not significant when patients were stratified using standard measurements, i.e., staining (p=0.891), TBUT (p=0.749), symptoms (p=0.719), or MGD status (p=0.852). In the hyperosmolar group (n=10), instillation of HA reduced OSI at 10, 15, and 30 minutes (p<0.001).>

CONCLUSIONS: Hyperosmolar eyes exhibited increased light scatter variation following cataract surgery compared with normal osmolarity eyes, which results in a 7-fold increase in post-surgical dissatisfaction. Therefore, hyperosmolarity may represent a key factor to address in order to improve patient outcomes and overall satisfaction after cataract surgery.