Transcript Cataract and Dry Eye: The PHACO Study (Prospective Health

W. B. Trattler; C. D. Reilly; D. F. Goldberg; P. A.
Majmudar; J. A. Vukich; M. Packer; E. D. Donnenfeld
Financial Disclosures
 William Trattler: Consultant/Research Funding &/OR
Speaking Honoraria: AMO, Lenstec, Wavetec
 Study funded by an unrestricted grant from Allergan
Purpose and Methods
 The purpose of this study was to determine the incidence and
severity of dry eye in patients undergoing cataract surgery
 Prospective, multi-center, observational, pilot study of 143
patients at least 55 years of age that were scheduled to
undergo cataract surgery.
 Outcome measures
 Incidence of dry eye as evaluated by grade on ITF level
 TBUT
 OSDI
 Corneal staining with fluorescein
 Conjunctival staining with lissamine
 Patient symptom questionnaire
Patient Enrollment
 143 consecutive patients (286 eyes) scheduled to undergo cataract
surgery and meeting all other inclusion/exclusion criteria were
enrolled at 9 sites across the United States
 7 of these patients (7/143, 4.9%) were presently using Restasis
and investigators completed a questionnaire about their use of
Restasis
 Additional data from these patients was not collected/not used
for the analysis of the remaining 136 patients (272 eyes)
 Of the 136 patients, 30 (22.1%) indicated a prior diagnosis of dry eye
disease
 If including the Restasis patients, this incidence increased to
25.9% (37/143)
Patient Demographics
Age
Mean (years)
SD
Min
Max
Gender
Male
Female
Race
Asian
Black
Caucasian
Hispanic
Other
70.7
7.8
54.5
87.9
n
%
68
68
50
50
11
5
100
15
5
8.1
3.8
73.5
11.0
3.7
ITF Scores
TBUT and Staining
•Most patients (62.9%) had an abnormal TBUT < 5 sec
•76.8% were positive for fluorescein corneal staining, with 50%
exhibiting positive central staining
Schirmer’s and OSDI
•21.3% of patients had an abnormal Schirmer’s score (< 5 mm)
Prevalence of Patient Symptoms
Prevalence of Patient Symptoms
•Lack of symptoms was not associated with lack of corneal staining:
• 61/136 patients (44.9%) had a corneal staining score of at least 1 but a
cumulative score of one or lower for burning/stinging, FBS, dryness, and
painful/sore.
Conclusions
 The findings of the present study suggest that
the prevalence of dry eye signs and symptoms in
patients undergoing cataract surgery is more
common than frequently reported:
 Most patients (62.9%) had an abnormal TBUT < 5 sec
 21.3% had an abnormal Schirmer’s score (< 5 mm)
 76.8% were positive for fluorescein corneal staining,
with 50% exhibiting positive central staining
Conclusions
 Despite only the minority of patients (22.1%) ever having
received a diagnosis of dry eye, more than 30% of
patients reported at least occasional stinging and
burning, dryness, and foreign body sensation, with more
than 40% reporting ocular itching, sensitivity to light,
blurred vision, and tired/fatigued eyes.
 In conclusion, increased awareness of the prevalence of
dry eye signs and symptoms should lead to proactive
treatment and careful monitoring for either surgicallyinduced dry eye or the exacerbation of dry eye disease
existent prior to undergoing cataract surgery.