Europe’s cataract surgery guidance now asks surgeons to address the ocular surface before they operate. For companies, that makes the most common operation in ophthalmology the moment a large, undertreated population finally comes within reach.

Executive summary

Ocular surface disease (OSD), a broad group of conditions that includes dry eye, eyelid inflammation and irregularities of the corneal surface, is highly prevalent: dry eye alone affects an estimated 15-30% of adults in European countries, and many of those affected are not actively managing it. Dry eye rarely feels urgent, and older patients tend to wait until vision fails before they present. But cataract surgery brings these patients back onto the treatment pathway. First, it is the moment when part of this population comes under an ophthalmologist’s care. Second, both surgeon and patient have reason to treat the disease, since good results depend on it, especially with premium lenses, where the patient has paid for a sharp outcome.

Cataract surgery is the most common operation in ophthalmology, with more than 5 million procedures a year in the EU¹⁴. And what patients expect from it is evolving - many now want sharp, glasses-free vision rather than simply the removal of a clouded lens, helped by premium intraocular lenses (the artificial lenses implanted during surgery) that can correct for distance, near vision and astigmatism at once. Getting those results depends on precise measurements of the eye beforehand, and those measurements depend in turn on the health of the ocular surface: the tear film, the front surface of the cornea and the eyelid margins that together form the eye’s outermost optical layer. Untreated, the disease distorts those measurements and undermines the result.

Guidance has now caught up with the evidence. In 2025, the ESCRS added preoperative dry eye treatment to its formal cataract surgery guideline - the first time a major European society has written surface care into the surgical pathway, following the equivalent American framework from 2019. Recommendations are now on paper on both sides of the Atlantic, but few surgeons have built surface care into their routine and few patients know to ask. That gap presents a commercial opportunity: demand for the diagnostics that detect surface disease and the range of drops, lid treatments and tear-film therapies that correct it before surgery. This opportunity is set to grow as surface care becomes routine in the premium segment where that result is paid for directly. This piece looks at why the ocular surface now shapes the surgical result, what is driving the shift towards treating it, and what that means commercially for companies working in ophthalmic surgery and surface care across European markets.

Introduction