Postoperative dry eye symptoms and secondary healthcare utilization in patients prior to, during, and after the COVID 19 pandemic
Authors: Milena Cioana 1, Sohel Somani1, Eric S. Tam1, Francesca Lee2, Saffire H. Krance3, Amin Hatamnejad4, Hannah H. Chiu1. 1Temerty Faculty of Medicine, University of Toronto, 2Faculty of Medicine and Health Sciences, McGill University, 3Schulich School of Medicine and Dentistry, Western University, 4Michael G. DeGroote School of Medicine, McMaster University.
Author Disclosures: M. Cioana: None. S. Somani: None. E.S. Tam: None. F. Lee: None. S.H. Krance: None. A. Hatamnejad: None. H.H. Chiu: None.
Abstract Body:
Purpose: Dry eye symptoms (DES) continue to be a significant side effect of cataract surgery affecting quality of life and satisfaction of patients postoperatively. The primary objective of this study is to compare DES in patients following uncomplicated cataract surgery prior to, during, and after the COVID-19 pandemic. Our secondary objective was to identify risk factors associated with postoperative dry eye symptoms.
Study Design: Retrospective chart review.
Methods: Data from consecutive patients who underwent uncomplicated cataract surgery in November 2019, 2020, and 2021 in a surgical centre in Ontario, Canada was extracted. Patients included were 18 years or older with preoperative Dry Eye Questionnaire 5 (DEQ5) scores (range: 0-2=none, 3-8=mild, 9-15=moderate, 16-22=severe DES). Sample size calculation based on previous studies was done, and 131 patients were included in each group. Preoperative DEQ5, prophylactic treatment, and presence of DES risk factors (ocular comorbidities, systemic diseases, use of glaucoma medications, intravitreal anti-VEGF injections, OPD mires suggestive of dry eye, previous corneal treatments) were recorded. Number of postoperative visits due to DES concerns were calculated. Odds ratios (OR) of risk of postoperative DES based on preoperative DEQ5 or prophylactic treatment were determined. DES risk factors were analyzed using multivariate regression.
Results: Preoperative DES prevalence and DEQ5 scores pre, during and post-COVID-19 decreased (mean±SD: 6.2±5.5, 3.4±4.4, 2.3±3.4, respectively, p<0.01). While the number of total follow-ups has decreased during and post-COVID-19, the percentage of follow-ups attributed to DES has increased (26%, 50%, 40%, respectively). Percentage of patients receiving prophylactic treatment preoperatively did not differ significantly between the groups (41.9%, 37.4%, 35.9%, respectively). In the during and post-COVID-19 groups there was a higher risk of postoperative DES with increasing preoperative DEQ5 score (OR=1.13, 95%CI 1.03-1.24 and OR=1.18, 95%CI 1.03-1.35, respectively). No other risk factors predicted DES, and there was no DES risk reduction in patients receiving preoperative treatment, regardless of DEQ5 score or group.
Conclusions: There has been an increase in postoperative DES during and after the COVID-19 pandemic despite a decrease in DES preoperatively. Preoperative DES treatment does not seem to reduce the burden of postoperative DES. More research is needed on DES treatment adherence to determine protective measures.
