Dry eye disease (DED) remains one of the most common, and often under-recognized, challenges in patients undergoing cataract surgery. Accurate preoperative measurements and optimal visual outcomes depend heavily on a stable ocular surface. Recent research evaluating perfluorohexyloctane ophthalmic solution (PFHO) offers encouraging evidence that clinicians can effectively treat dry eye without compromising the biometric measurements that guide intraocular lens (IOL) selection.
Why this study was conducted
The study was designed to answer two key clinical questions. First, investigators wanted to determine whether PFHO, known for its long ocular surface residence time, would interfere with preoperative biometry and keratometry measurements when used four times daily for 30 days before cataract surgery and 30 days postoperatively. Second, the researchers aimed to evaluate whether this treatment regimen would improve the signs and symptoms of dry eye disease in patients undergoing cataract surgery.
Stability of refractive outcomes
One of the most important findings from the study was that PFHO treatment did not negatively affect refractive outcomes. In fact, refractive predictability remained stable throughout treatment. After PFHO therapy, 82.6% of patients were within ±0.50 diopters of predicted manifest refraction spherical equivalent, compared with 80.2% prior to treatment.
Accurate keratometry and biometry measurements are essential to achieving targeted refractive outcomes after cataract surgery. These results suggest clinicians can confidently manage dry eye with PFHO, without worrying that the therapy will compromise IOL calculations or surgical planning.
Meaningful improvements in ocular surface health
Beyond measurement stability, the study also demonstrated notable improvements in clinical signs of dry eye disease. Total corneal fluorescein staining improved substantially, decreasing from a baseline score of 5.0 to 1.3 at the final visit. Central corneal staining similarly improved from 0.9 to 0.2. After 30 days of preoperative PFHO therapy, 75.8% of patients had no central corneal staining. A clear central cornea is critical for optimal visual outcomes, and clinicians want to ensure the ocular surface is as healthy as possible before patients enter the operating room. This result underscores the importance of proactive ocular surface optimization prior to surgery.
Symptom relief
Participants in the study entered with severe dry eye symptoms, reflected by a baseline eye dryness score of 62.3 and an Ocular Surface Disease Index (OSDI) score of 51.9.
Following treatment both before and after surgery, those numbers improved dramatically. By the final visit, the eye dryness score decreased to 25.9, and the mean OSDI score dropped to 11.9.
Notably, this was the first PFHO trial in which the mean OSDI score of participants normalized by the end of the study. All improvements in both signs and symptoms were statistically significant, whether measured across the entire study period, during the preoperative treatment phase alone, or during the postoperative treatment phase.
Additional positive trends
Several additional findings stood out. Investigators observed a trend toward improved IOL calculation accuracy after PFHO therapy. When comparing predicted versus correct IOL calculations, 84% of patients were within ±0.5 diopters following preoperative PFHO treatment, compared with 72% at baseline.
The study also evaluated higher-order aberrations, which are particularly important in patients receiving premium or diffractive IOLs. Encouragingly, 74.5% of patients experienced either improvement or stability in higher-order aberrations during treatment.
These findings suggest that treating dry eye with PFHO may help maintain — or potentially improve — optical quality, an important factor when pursuing advanced refractive outcomes in cataract surgery.
Postoperative visual outcomes
Another noteworthy observation was the continued improvement in best-corrected visual acuity (BCVA) following the 30-day postoperative treatment period. The percentage of patients with a BCVA of 20/20 or better increased from 86% at V3 to 92% at V4. Many cataract patients are already satisfied with their vision at their one-month postoperative visit, yet continued PFHO therapy allowed additional patients to achieve BCVA of 20/20 or better.
This reinforces the idea that ocular surface optimization should not end once surgery is complete.
Future research directions
While the results are promising, further investigation could strengthen these findings. Future studies could include a larger patient population, incorporate an untreated control arm, and extend follow-up to three or six months to evaluate longer-term outcomes.
Implications for your practice
For eye doctors managing patients throughout the cataract surgery journey, these findings offer reassurance. Treating dry eye disease aggressively — particularly with therapies that improve ocular surface stability — can enhance both patient comfort and surgical outcomes.
The data suggest that PFHO can effectively improve signs and symptoms of dry eye before and after cataract surgery without disrupting the measurements critical to refractive accuracy. In an era where patients increasingly expect premium visual outcomes, ensuring a stable and healthy ocular surface remains one of the most important steps in achieving surgical success.
