This meibography image was captured in 64-year-old female awaiting cataract surgery (OSDI-6: 4) with the handheld MEA device.

Many patients presenting for cataract surgery have undiagnosed dry eye and meibomian gland dysfunction (MGD). An unstable tear film can distort biometry and corneal topography, increasing the risk of refractive surprises, particularly with toric and multifocal IOLs. Poor tear film quality has been linked to altered measurements, reduced image quality, and lower patient satisfaction, even after technically successful cataract surgery.

If undiagnosed MGD and untreated dry eye can compromise pre-operative measurements, is dedicated meibomian gland evaluation and dry eye assessment the missing step in cataract surgery work-up?