Preoperative Ocular Surface Optimization Protocol Sharpen Surgical Precision, Suggests Study

With cataracts recognized by the World Health Organization (WHO) as the foremost cause of preventable blindness globally, Katarzyna Biela and her team at the Medical University of Lublin conducted the research to address the significant clinical gap caused by underdiagnosed dry eye disease (DED), which frequently compromises biometry accuracy in the elderly population, specifically aiming to determine if a short-term preoperative optimization protocol could improve refractive predictability for all patients regardless of their baseline surface health.

Therefore, the non-randomized prospective trial analyzed 70 participants—excluding those with irregular axial lengths or recent topical medication use—who were assigned to DED treatment, non-DED treatment, or control groups to evaluate a two-week regimen of trehalose moisturizing drops and eyelid hygiene using the IOL Master 500 and Haigis formula to track changes in MAE and keratometry as primary and secondary endpoints.

Key Clinical Findings of the Study Includes:

• Significant Error Reduction: The study showed that symptomatic patients experienced a marked improvement in refractive accuracy, with their MAE decreasing from 0.39 ± 0.31 D to 0.27 ± 0.30 D after just fourteen days of targeted treatment, as credited by this research.

• Benefit in Asymptomatic Patients: Even participants who were initially considered healthy saw their error values drop significantly from 0.30 ± 0.25 D to 0.24 ± 0.20 D following the optimization protocol.

• High Prevalence of Undetected Disease: Objective clinical screening revealed the critical finding that 75% of patients who reported no symptoms actually suffered from at least one sign of ocular surface instability, such as abnormal tear break-up time or corneal staining.

• Astigmatism Variability: While most biometric variables were consistent, the researchers identified corneal astigmatism as the most volatile parameter in the DED cohort, suggesting that untreated surface issues could specifically undermine the precision of astigmatic corrections.

• Clinical Success Thresholds: The intervention was highly effective, enabling 90% of the treated DED group to achieve a postoperative refractive result within ±0.75 D, which aligns with modern standards for surgical excellence.

The results suggest that stabilizing the tear film through a brief course of moisturizing drops and eyelid hygiene significantly enhances the reliability of preoperative measurements, leading to a statistically significant reduction in the MAE (p < 0.001) and ensuring more predictable visual outcomes for patients.

Implementing a brief preoperative regimen of moisturizing drops and eyelid hygiene for all cataract patients, regardless of their symptomatic status, may provide a simple yet effective strategy to enhance the precision of lens power calculations and final visual outcomes.

While the study was limited by its non-randomized design and declarative patient compliance, these findings underscore the value of exploring further standardized preoperative management protocols to consistently optimize the ocular surface before surgery.

Reference

Biela, K.; Winiarczyk, M.; Gumieniak-Goch, B.; Mackiewicz, J. The Effect of Dry Eye Disease Treatment Prior to Cataract Surgery on Refractive Error Reduction. Journal of Clinical Medicine 2026, 15, 545.