Effect of tear osmolarity on postoperative refractive error after cataract surgery


  • Anete Kursite Riga Stradins University, P Stradins Clinical University Hospital
  • Guna Laganovska Riga Stradins University, P Stradins Clinical University Hospital




tear osmolarity, dry eye disease, cataract surgery, refractive error


Purpose: To analyze the effects of tear osmolarity on postoperative refractive error and patient satisfaction after cataract surgery.

Methods: The patients were divided into two groups based on the tear osmolarity (group Nr 1-normal tear osmolarity, <310 mOsm/L; group Nr 2-hyperosmolar, >310 mOsm/L). Preoperative and postoperative (1 month after surgery) visual acuities (VAs), refractions, and best corrected VAs (BCVAs) were measured. The postoperative refractive error was measured as the spherical equivalent (SE) (SE = sphere + [0.5 × cylinder]). The postoperative VA, BCVA, and SE were compared between groups.

Results: Eighty-one patients were included in the study (group Nr 1=40 patients and group Nr 2=41 patients). The hyperosmolar group had a statistically significant higher postoperative refractive error (p<0.01, mean SE for group Nr 1=0.284; mean SE for group Nr 2=0.604) and lower VA after surgery (p<0.01, mean VA for group Nr 1=0.891; mean VA for group Nr 2=0.762).

Conclusions: Increased tear osmolarity can affect the planned outcome of cataract surgery as an unexpected refractive error. Measuring tear osmolarity before routine cataract surgery would help achieve accurate results and improve postoperative patient satisfaction.

Author Biographies

Anete Kursite, Riga Stradins University, P Stradins Clinical University Hospital


Guna Laganovska , Riga Stradins University, P Stradins Clinical University Hospital



Ang RET, Quinto MMS, Cruz EM, Rivera MCR, Martinez GHA. Comparison of clinical outcomes between femtosecond laser-assisted versus conventional phacoemulsification. Eye Vis (Lond). 2018 Apr 23;5:8. https://doi.org/10.1186/s40662-018-0102-5

Davis G. The Evolution of Cataract Surgery. Mo Med. 2016;113(1):58-62.

Chen M. Refractive cataract surgery - what we were, what we are, and what we will be: A personal experience and perspective. Taiwan J Ophthalmol. 2019 Jan-Mar;9(1):1-3. https://doi.org/10.4103/tjo.tjo_133_18

Richard Lindstrom. Thoughts on Cataract Surgery: 2015. [cited 2022 Jun 17]. Available from: https://www.reviewofophthalmology.com/article/thoughts-on--cataract-surgery-2015.

Jin, S., & Lee, J. Refractive surgical corrective options after cataract surgery. Annals Of Eye Science. 2019; 4(3), 12. https://doi.org/10.21037/aes.2019.01.02

Kim K. Preoperative factors causing refractive errors after cataract surgery. Investigative Ophthalmology & Visual Science July 2019, Vol.60, 492.

Lundström M, Dickman M, Henry Y, Manning S, Rosen P, Tassignon MJ, et al. Risk factors for refractive error after cataract surgery: Analysis of 282 811 cataract extractions reported to the European Registry of Quality Outcomes for cataract and refractive surgery. J Cataract Refract Surg. 2018 Apr;44(4):447-452. https://doi.org/10.1016/j.jcrs.2018.01.031

Ladi, Jeevan S. Prevention and correction of residual refractive errors after cataract surgery. Journal of Clinical Ophthalmology and Research. 2017. 5. 45. https://doi.org/10.4103/2320-3897.195311

Lee AC, Qazi MA, Pepose JS. Biometry and intraocular lens power calculation. Curr Opin Ophthalmol. 2008 Jan;19(1):13-7. https://doi.org/10.1097/ICU.0b013e3282f1c5ad

Khan L, Sharma B, Gupta H, Rana R. Accuracy of biometry using automated and manual keratometry for intraocular lens power calculation. Taiwan J Ophthalmol. 2018 Apr-Jun;8(2):93-98. https://doi.org/10.4103/tjo.tjo_58_17

Turczynowska M, Koźlik-Nowakowska K, Gaca-Wysocka M, Grzybowski A. Effective Ocular Biometry and Intraocular Lens Power Calculation. European Ophthalmic Review, 2016;10(2):94-100 https://doi.org/10.17925/EOR.2016.10.02.94

Epitropoulos AT, Matossian C, Berdy GJ, Malhotra RP, Potvin R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015 Aug;41(8):1672-7. https://doi.org/10.1016/j.jcrs.2015.01.016

Matossian S. How the tear film affects IOL measurements. Optometry Times Journal, August digital edition 2020, Volume 12, Issue 8. [cited 2022 Jun 17]. Available from: https://www.optometrytimes.com/view/how-the-tear-film-affects-iol-measurements.

Willcox MDP, Argüeso P, Georgiev GA, Holopainen JM, Laurie GW, Millar TJ, et al. TFOS DEWS II Tear Film Report. Ocul Surf. 2017 Jul;15(3):366-403. https://doi.org/10.1016/j.jtos.2017.03.006

Stapleton F, Alves M, Bunya VY, Jalbert I, Lekhanont K, Malet F, et al. TFOS DEWS II Epidemiology Report. Ocul Surf. 2017 Jul;15(3):334-365. https://doi.org/10.1016/j.jtos.2017.05.003

Gupta, Preeya, Drinkwater, Owen, VanDusen, Keith, et al. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. Journal of Cataract & Refractive Surgery. 2018 Sep. 44(9):p 1090-1096. https://doi.org/10.1016/j.jcrs.2018.06.026

Naderi K, Gormley J, O'Brart D. Cataract surgery and dry eye disease: A review. Eur J Ophthalmol. 2020 Sep;30(5):840-855. https://doi.org/10.1177/1120672120929958

Chien KJ, Horng CT, Huang YS, Hsieh YH, Wang CJ, Yang JS, et al. Effects of Lycium barbarum (goji berry) on dry eye disease in rats. Mol Med Rep. 2018 Jan;17(1):809-818. https://doi.org/10.3892/mmr.2017.7947

Massof RW, McDonnell PJ. Latent dry eye disease state variable. Invest Ophthalmol Vis Sci. 2012 Apr 6;53(4):1905-16. https://doi.org/10.1167/iovs.11-7768

Tomlinson A, Khanal S, Ramaesh K, Diaper C, McFadyen A. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4309-15. https://doi.org/10.1167/iovs.05-1504

Lemp MA, Bron AJ, Baudouin C, Benítez Del Castillo JM, Geffen D, Tauber J, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011 May;151(5):792-798. https://doi.org/10.1016/j.ajo.2010.10.032

Hiraoka T, Asano H, Ogami T, Nakano S, Okamoto Y, Yamada Y, et al. Influence of Dry Eye Disease on the Measurement Repeatability of Corneal Curvature Radius and Axial Length in Patients with Cataract. J Clin Med. 2022 Jan 28;11(3):710. https://doi.org/10.3390/jcm11030710

Kim J., Kim M.K., Ha Y., Dong H.K. Improved accuracy of intraocular lens power calculation by preoperative management of dry eye disease. BMC Ophthalmol 21, 364 (2021). https://doi.org/10.1186/s12886-021-02129-5

PotvinR, Makari S, Rapuano CJ. Tear film osmolarity and dry eye disease: a review of the literature. Clin Ophthalmol. 2015 Nov 2;9:2039-47. https://doi.org/10.2147/OPTH.S95242

Ubeid AMR. The Unsatisfied Patient after Cataract Surgery Ocular Surface Disease as a Major Contributor. Int J Ophthalmol Clin Res 5:095.

Siew L, Tong L. The Effect of Past Cataract Surgery within the Medium to Long-Term Period on Patients with Dry Eye Disease. J Clin Med. 2022 Feb 13;11(4):972. https://doi.org/10.3390/jcm11040972

Szakáts I, Sebestyén M, Tóth É, Purebl G. Dry Eye Symptoms, Patient-Reported Visual Functioning, and Health Anxiety Influencing Patient Satisfaction After Cataract Surgery. Curr Eye Res. 2017 Jun;42(6):832-836. https://doi.org/10.1080/02713683.2016.1262429

Miura, M., Inomata, T., Nakamura, M,Sung, J., Nagino, K., Midorikawa- Inomata, A, et al. Prevalence and Characteristics of Dry Eye Disease After Cataract Surgery: A Systematic Review and Meta-Analysis. Ophthalmol Ther 11, 1309-1332 (2022). https://doi.org/10.1007/s40123-022-00513-y

Elksnis Ē, Lāce I, Laganovska G, Erts R. Tear osmolarity after cataract surgery. J Curr Ophthalmol. 2018 Sep 24;31(1):31-35. https://doi.org/10.1016/j.joco.2018.08.006

Sajnani R, Raia S, Gibbons A, Chang V, Karp CL, Sarantopoulos CD, et al. Epidemiology of Persistent Postsurgical Pain Manifesting as Dry Eye-Like Symptoms After Cataract Surgery. Cornea. 2018 Dec;37(12):1535-1541. https://doi.org/10.1097/ICO.0000000000001741

Taylor HR, Vu HTV, Keeffe JE. Visual Acuity Thresholds for Cataract Surgery and the Changing Australian Population. Arch Ophthalmol. 2006;124(12):1750-1753. https://doi.org/10.1001/archopht.124.12.1750

Chen Z, Lin X, Qu B, Gao W, Zuo Y, Peng W, et al. Preoperative Expectations and Postoperative Outcomes of Visual Functioning among Cataract Patients in Urban Southern China. Plos One. 2017 Jan. https://doi.org/10.1371/journal.pone.0169844

Xu, C. Successful Premium Multifocal IOL Surgery: Key Issues and Pearls. Current Cataract Surgical Techniques. London: IntechOpen; 2021 [cited 2023 Jan 02]. Available from: https://www.intechopen.com/chapters/75474 https://doi.org/10.5772/intechopen.96182



How to Cite

Kursite A, Laganovska G. Effect of tear osmolarity on postoperative refractive error after cataract surgery. JO (Ukraine) [Internet]. 2023 Apr. 25 [cited 2023 Jun. 7];(2):11-5. Available from: https://ua.ozhurnal.com/index.php/files/article/view/20



Clinical Ophthalmology