Thyroid Eye Disease Linked With Refractive Prediction Error After Cataract Surgery

Process of cataract surgery in modern clinic
The researchers highlight the importance of discussing the potential for continued spectacle use and additional needs with patients following surgery.

Patients with thyroid eye disease (TED) are at increased risk for refractive prediction error following cataract surgery, according to findings published in Clinical Ophthalmology.

Researchers conducted a retrospective observational study wherein records of patients who had undergone cataract surgery between 2014 and 2018 were analyzed. Patients were included if TED was documented on their record. The main outcome measure was postoperative refractive error ±1.0 D from the target refraction. Eyes were excluded if their record indicated a history of refractive surgery, ocular trauma, retinal detachment, non-Graves’ disease thyroid conditions, or Graves’ disease without TED. In total, 5716 eyes from 3692 patients were analyzed.

The study found that 65 eyes of 29 patients (1.1%) had TED. Having TED was associated with former or current smoking status (P =.05). Eyes with TED had a shorter axial length that was statistically significant (P =.03) compared with eyes without TED. Refractive prediction error was ±1.0 diopter following surgery in 349 eyes (6.1%), including 9 eyes (13.8%) in patients with TED (P =.03). TED was associated with refractive prediction error ±1.0 diopter after multivariate analysis controlling for race, tobacco use, combined surgery, and axial length (P =.05). 

The researchers explain that patients with TED may be at increased risk for unexpected refractive prediction error after cataract surgery due to the pathology of TED and the multiple surgeries often required. The study notes “We found that patients with TED were more than twice as likely to have refraction prediction error outside of 1.0 D.”

“Several investigators have described myopic, hyperopic, and cylinder axis changes in patients with TED independent from cataract surgery,” the researchers explained. They also noted the “pathologic swelling and fibrosis of the muscles and soft tissues in the orbit [that] is thought to alter the shape of the eye through compressive forces.”

Although the P-value of this association did not quite reach statistical significance this result was likely confounded by the small number of eyes with TED that were included in the study.

Study limitations included its retrospective nature and reliance on medical chart review.


Strong Caldwell A, Patnaik JL, Ackerman M, Christopher KL, Lynch AM, Singh JK. Risk of Refractive Prediction Error After Cataract Surgery in Patients with Thyroid Eye Disease. Clin Ophthalmol. 2021;11(15):4431-4438. doi:10.2147/OPTH.S337360