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Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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Tear film osmolarity in a consecutive cohort of 1150 patients undergoing refractive surgery assessment

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Session Details

Session Title: SMILE vs PRK, Ocular Surface Disease

Session Date/Time: Monday 24/09/2018 | 08:00-10:30

Paper Time: 09:28

Venue: Room A3, Podium 3

First Author: : M.Lawless AUSTRALIA

Co Author(s): :    G. Sutton   C. Hodge                 

Abstract Details


Preoperative dry eye represents a risk for sub-optimal results following refractive surgery. Identification and treatment of at-risk individuals is essential to optimise outcomes. This study analyses tear film osmolarity in a large, consecutive group of patients presenting for refractive surgery assessment. Our aim was to highlight the characteristics and incidence of tear film abnormalities in a standard, real world, refractive surgery population.


Patients undergoing an initial refractive surgery consultation at a single private ophthalmic surgery centre


1150 patients undergoing screening for laser refractive surgery from October 2016 through to October 2017 were reviewed. Routine examination included visual acuity, refraction, dry eye testing including tear film osmolarity (TFO) and the Ocular Surface Disease Index (OSDI) questionnaire. Osmolarity was conducted prior to further tests and patients instructed to refrain from topical eye drops for a minimum of two hours before the appointment.


Mean TFO was 300.42 ±11.28mOsm/L with 80.0% of eyes <308mOsm/L indicating normal tear film homeostasis. Mean inter-eye TFO difference was 8.7±8.4mOsm/L with 39.2% greater than 8mOsm/L. TFO was positively correlated with age, inter-eye difference and spherical equivalent. TFO correlated to subjective dry eye in a subset of OSDI patients. There was no correlation between TFO and time of day the assessment took place. Multivariate analysis indicated that age and contact lens wear were significant factors in determining tear osmolarity values (age p = 0.040 and adjusted r2 = 0.011, contact Lens wear p = 0.006 and adjusted r2 = 0.017).


Almost one-fifth of routine patients presenting for refractive surgery assessment exhibited tear film hyperosmolarity. These patients may or may not have dry eye symptoms as demonstrated on the OSDI questionnaire. Screening tear osmolarity testing in all patients, in a standardized manner, allows us to identify those who require treatment to optimize the tear film prior to corneal laser surgery or prior to biometry for intraocular lens calculations.

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