1. W. B. Trattler; C. D. Reilly; D. F. Goldberg; P. A. Majmudar; J. A. Vukich; M. Packer; E. D. Donnenfeld

2. Financial Disclosures William Trattler: Consultant/Research Funding &/OR Speaking Honoraria: AMO, Lenstec, Wavetec Study funded by an unrestricted grant from Allergan

3. Purpose and Methods The purpose of this study was to determine the incidence and severity of dry eye in patients undergoing cataract surgery Prospective, multi-center, observational, pilot study of 143 patients at least 55 years of age that were scheduled to undergo cataract surgery. Outcome measures Incidence of dry eye as evaluated by grade on ITF level TBUT OSDI Corneal staining with fluorescein Conjunctival staining with lissamine Patient symptom questionnaire

4. Patient Enrollment 143 consecutive patients (286 eyes) scheduled to undergo cataract surgery and meeting all other inclusion/exclusion criteria were enrolled at 9 sites across the United States 7 of these patients (7/143, 4.9%) were presently using Restasis and investigators completed a questionnaire about their use of Restasis Additional data from these patients was not collected/not used for the analysis of the remaining 136 patients (272 eyes) Of the 136 patients, 30 (22.1%) indicated a prior diagnosis of dry eye disease If including the Restasis patients, this incidence increased to 25.9% (37/143)

5. Patient Demographics

6. ITF Scores

7. TBUT and Staining Most patients (62.9%) had an abnormal TBUT < 5 sec 76.8% were positive for fluorescein corneal staining, with 50% exhibiting positive central staining

8. Schirmer’s and OSDI 21.3% of patients had an abnormal Schirmer’s score (< 5 mm)

9. Prevalence of Patient Symptoms

10. Lack of symptoms was not associated with lack of corneal staining: 61/136 patients (44.9%) had a corneal staining score of at least 1 but a cumulative score of one or lower for burning/stinging, FBS, dryness, and painful/sore.

11. Conclusions The findings of the present study suggest that the prevalence of dry eye signs and symptoms in patients undergoing cataract surgery is more common than frequently reported: Most patients (62.9%) had an abnormal TBUT < 5 sec 21.3% had an abnormal Schirmer’s score (< 5 mm) 76.8% were positive for fluorescein corneal staining, with 50% exhibiting positive central staining

12. Conclusions Despite only the minority of patients (22.1%) ever having received a diagnosis of dry eye, more than 30% of patients reported at least occasional stinging and burning, dryness, and foreign body sensation, with more than 40% reporting ocular itching, sensitivity to light, blurred vision, and tired/fatigued eyes. In conclusion, increased awareness of the prevalence of dry eye signs and symptoms should lead to proactive treatment and careful monitoring for either surgically- induced dry eye or the exacerbation of dry eye disease existent prior to undergoing cataract surgery.