Patient: Tear film issues resulting in poor visual outcomes are a major cause of dissatisfaction after cataract surgery. There is no universal best preoperative algorithm for managing the ocular surface prior to surgery.

Industry: Recent advances in tear/cornea imaging and refractive cataract surgery such as multifocal intraocular lenses will be advantageous to patients only if tear film issues can be addressed.

Society: Cataract surgery is the most common ophthalmic surgery done in Singapore and worldwide. Improving vision by attending to tear film problems improves quality of life.

Phase 1: Investigate the impact of ocular surface disease (OSD) on post-operative outcomes in cataract surgery.

Phase 1A: Longitudinal interventional parallel group study; small cohort to determine the impact of moderate dry eye for at-risk patient groups.

Phase 1B: Longitudinal interventional parallel group study; larger cohort of to compare outcomes based on different IOL types.

Inclusion Criteria:

• Inclusion criteria for dry eye (participant must meet at least 1 of the inclusion criteria below):

  1. Symptomatic for dry eye based on DEQ5 (>6) and [either TBUT less than 5 s or staining >grade 1 in any zone of the cornea]
  2. Either use of diquasfosol, cyclosporine eyedrops or tacrolimus eyedrops for dry eye disease in the last 2 weeks (and previously started for more than 2 months), OR current and visible lower punctal plugs in at least one eye

Inclusion criteria to fulfil all for controls (patients w/o dry eye):

1. DEQ5 <=6.
2. Staining < grade 1 in at least one corneal zone.
3. Not using diquasfosol, cyclosporine, tacrolimus in last 2 months.
4. No visible punctal plugs.

Exclusion Criteria:

• If there is another ocular condition which affects vision as much as cataract: active corneal stromal disease or scar or significant corneal endothelial disease
• Known diagnosis of active thyroid dysfunction, Sjogren disease and rheumatoid arthritis
• Intraocular surgery within the previous 6 months
• Laser-assisted in situ keratomileusis or pterygium surgery within the previous 3 months
• Central nervous system and hormonal drugs required within the last month and during the study
• Active ocular infection, inflamed chalazion, or presence of pterygium
• Glaucoma which requires topical anti-glaucoma medications
• Any need to wear contact lens during the study
• Having issues which make it difficult to follow up (eg., wheelchair, etc)
• Pregnant and breast-feeding woman

Patient undergoing cataract surgery that met the study inclusion and exclusion