Rate of Hyperosmolar Tear Film After Cataract Surgery, With Amar Shah, MD

A new prospective study at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting highlighted a significant gap in ocular surface recovery following cataract surgery, with more than a third of patients showing elevated tear film osmolarity one month after surgery despite standard postoperative care.

The study at the Cincinnati Eye Institute enrolled 71 patients scheduled for cataract surgery. Tear osmolarity was measured using the ScoutPro Osmolarity System before surgery and again at the 30-day postoperative visit. Hyperosmolarity was defined as ≥ 315 mOsm/L, following ASCRS guidelines for ocular surface disease (OSD).

At baseline, 44% of patients (31 of 71) were found to have hyperosmolar tear film. Among the 59 patients who returned for the 30-day follow-up, 31% of those with normal osmolarity preoperatively developed hyperosmolarity. Meanwhile, only 50% of those who started with elevated osmolarity saw normalization by day 30, despite treatment with antibiotics, corticosteroids, NSAIDs, and artificial tears.

In an interview with HCPLive, presenting investigator Amar Shah, MD, a cataract, refractive, and cornea surgeon at Mid-Ohio Eye, noted that a central feature of dry eye disease is hyperosmolarity of the tear film. He indicated the value of obtaining information on whether a tear osmolarity is elevated or abnormal, suggesting its presence can lead to light scatter comparable to a grade two or three cataract.

“While in a cataract, the amount of light scatter is pretty constant, because the cataract is either there or not,” Shah told HCPLive. “In hyperosmolar tear film, the light scatter is more fluctuating between blinks or throughout the course of the day. This can be a little bit harder to identify, because we can't see alterations in osmolarity at the slit lamp.”

Shah emphasized that the persistence of hyperosmolarity despite a conventional drop regimen suggests the need for more targeted interventions. He pointed to options ranging from preservative-free artificial tears to prescription therapies like cyclosporine, lifitegrast, or punctal occlusion.

“This suggests that despite what we consider routine post-operative drops, there certainly could be an opportunity to add additional treatment to address these alterations in tear osmolarity,” Shah told HCPLive. “This can range from as simple as over-the-counter interventions like high-quality, preservative-free artificial lubrication or ointments, or it could be escalated up to any number of our bevy of available prescription treatment options.”

With increasing use of premium intraocular lenses and rising patient expectations, Shah stressed that managing the ocular surface is critical to visual outcomes.

“There’s an opportunity to be a little bit more aggressive in our management of ocular surface disease, pre- and post-operatively, especially in our modern era where patients' expectations are higher,” Shah told HCPLive. “The utilization of advanced technology interactive lenses is increasing, and the bar that we need to meet and exceed is growing higher and higher.”

Shah reports no relevant disclosures.

Reference

Shah AP, Barfell AD. The Prevalence of Hyperosmolar Tear Film in Patients Pre- and 30-Days-Post Cataract Surgery. Paper presented at the 2025 American Society of Cataract and Refractive Surgery (ASCRS) Annual Meeting. April 25-28, 2025. Los Angeles, CA.