Association of Cataract History with Dry Eye Disease Signs and Symptoms in the DREAM Study

Abstract

Background: Dry eye disease (DED) and cataracts are highly prevalent ocular conditions, particularly among older adults. However, the relationship between cataracts, cataract surgery, and DED severity remains poorly understood. This study aimed to assess the associations between cataract history and DED signs and symptoms in participants with moderate-to-severe DED. Methods: This is a secondary analysis of data from a double-blind randomized control trial of participants (n = 535) with moderate-to-severe DED in the DREAM Study. At baseline, cataract history and patient characteristics were collected; DED signs and symptoms were assessed at baseline, 6 and 12 months. Cataract history was classified as: no history of cataracts, ongoing cataracts (clinically diagnosed cataracts without surgical intervention), or history of cataract surgery >6 months prior to enrollment. Associations between cataract history and DED signs and symptoms were evaluated by univariate and multivariate regression analysis. Results: Among 1070 eyes from 535 participants, 646 eyes (60%) had no history of cataracts, 244 eyes (23%) had ongoing cataracts, and 180 eyes (17%) had a history of cataract surgery >6 months prior. On univariate analysis of the combined data from baseline, 6 and 12 months, corneal staining scores were significantly worse in eyes with a history of cataract surgery than eyes with ongoing cataracts and eyes without history of cataracts (4.08 vs 3.63 vs 3.14; P=0.005). However, the difference became non-significant after adjustment by age alone (3.62 vs 3.38 vs 3.37, P=0.71) or by factors associated with DED severity (P=0.72). In multivariate analysis, meibomian gland dysfunction was significantly worse in eyes with no history of cataracts than in eyes with ongoing cataracts or with history of cataract surgery (3.1 vs 2.7 vs 2.6; P=0.02). Conclusion: Cataract surgery was not independently associated with worse DED symptoms and signs. This indicates that exacerbations of DED severity following cataract surgery are either age-related or transient in patients with moderate-to-severe DED.