PURPOSE: To identify the prevalence of hyperosmolar tear film in a pre-surgical (pre-Sx) cataract and 30-day post-surgical (post-Sx) patient population.

METHOD: This was a prospective, observational cohort study at the Cincinnati Eye Institute, Cincinnati, Ohio. Subjects presenting for pre-Sx cataract evaluations were selected randomly. Tear fluid osmolarity was measured bilaterally at pre-Sx evaluation and at the 30-days post-Sx visit using the ScoutPro Osmolarity System (Bausch & Lomb, New Jersey). The higher of the two eyes was used for clinical assessment at each time point. A cut-off of ≥ 315 mOsm/L was selected to define cohorts with visually significant ocular surface disease (OSD) per the American Society of Cataract and Refractive Surgery algorithm for preoperative diagnosis and treatment of ocular surface disease.

RESULTS: 71 subjects were tested (mean age 63.1±14.8; 45 Females, 26 Males), of which 31 subjects (44%) exhibited elevated osmolarity ≥ 315 mOsm/L. At the 30-day post-surgical visit, 59 of the original 71 subjects followed up. 31% of the pre-Sx normal (is normal < 308 or less than 315?) subjects became hyperosmolar post-surgery. Only 50% of the pre-Sx hyperosmolar patients normalized despite topical corticosteroid, NSAID, anti-bacterial and artificial tear treatment during the post operative period.

CONCLUSION: Hyperosmolarity is common 30 days following cataract surgery suggesting an impact on the ocular surface unresolved by standard therapeutic routine. Risk of elevated light-scatter and visually significant sequelae from a hyperosmolar tear film may lead to poor patient satisfaction and visual quality requiring additional targeted therapy.