{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:22:59Z","timestamp":1791562979732,"version":"4.3.4"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study aimed to revise data published in the literature on the effects of cataract surgery on tear film characteristics, in relation to personal clinical surgical experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A search was undertaken using PubMed (all years). Search terms included \u2018cataract surgery\u2019, \u2018phacoemulsification\u2019, \u2018cataract extraction\u2019, and \u2018manual small-incision cataract surgery\u2019, combined at first with \u2018ocular surface\u2019 and \u2018lacrimal film\u2019. Second, we combined terms as \u2018cataract surgery\u2019, \u2018phacoemulsification\u2019, \u2018cataract extraction\u2019, \u2018manual small-incision cataract surgery\u2019 with \u2018dry eye disease (DED)\u2019 and \u2018dry eye syndrome\u2019. Third, we combined terms such as \u2018cataract surgery\u2019, \u2018phacoemulsification\u2019, \u2018cataract extraction\u2019, and \u2018manual small-incision cataract surgery\u2019 with \u2018conjunctival sensitivity\u2019 and \u2018sensitivity of the conjunctiva\u2019. Finally, we combined terms as \u2018cataract surgery\u2019, \u2018phacoemulsification\u2019, \u2018cataract extraction\u2019, and \u2018manual small-incision cataract surgery\u2019 with \u2018epiphora\u2019 and \u2018excessive tear\u2019. Relevant in-article references not returned in our searches were also considered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analyzed collected data regarding DED characteristics and management of this condition related to cataract surgery. The relationship between ocular surface signs and symptoms and cataract surgery appears to be strong; indeed, TBUT, Schirmer\u2019s test, and OSDI scores are abnormal as early as 2\u202fweeks after cataract surgery; however, there is conflicting evidence concerning the duration of these alterations and the restoration of the preoperative conditions, generally within 6\u202fmonths after surgery. An increased risk of DED after cataract surgery is associated with pre-existing MGD. The chosen surgical procedure and pre- and postoperative pharmacological management are also key points in determining the extent of postoperative DED. Finally, no remarkable evidence was found regarding the association of \u201ccataract surgery\u201d with \u201chyperlacrimation\u201d or \u201cconjunctival sensitivity.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The available evidence is discrepant regarding the onset, progression, and management of this condition. However, the association between cataract surgery and the occurrence of DED thereafter is well documented. Multicenter randomized trials are needed to strengthen the already published data, to investigate these divergencies, and to establish diagnostic-therapeutic protocols to manage this condition.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1559323","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T05:20:34Z","timestamp":1755580834000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The impact of cataract surgery on tear film physiology: signs and symptoms, progression and treatment"],"prefix":"10.3389","volume":"12","author":[{"given":"Alessia","family":"Nuzzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Tibaldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Nuzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1016\/S0140-6736(17)30544-5","article-title":"Cataracts","volume":"390","author":"Liu","year":"2017","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1016\/j.jcrs.2013.03.027","article-title":"Increasing incidence of cataract surgery: population-based study","volume":"39","author":"Gollogly","year":"2013","journal-title":"J Cataract Refract Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.jtos.2017.05.008","article-title":"TFOS DEWS II definition and classification report","volume":"15","author":"Craig","year":"2017","journal-title":"Ocul Surf"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.2147\/OPTH.S89700","article-title":"Associations between signs and symptoms of dry eye disease: a systematic review","volume":"9","author":"Bartlett","year":"2015","journal-title":"Clin Ophthalmol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.ophtha.2016.11.008","article-title":"Predictors of discordance between symptoms and signs in dry eye disease","volume":"124","author":"Vehof","year":"2017","journal-title":"Ophthalmology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.ajo.2006.11.060","article-title":"Impact of dry eye syndrome on vision-related quality of life","volume":"143","author":"Miljanovi\u0107","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"5722","DOI":"10.1167\/iovs.11-9094","article-title":"Assessment of vision-related quality of life in dry eye patients","volume":"53","author":"Li","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1080\/02713683.2016.1262429","article-title":"Dry eye symptoms, patient-reported visual functioning, and health anxiety influencing patient satisfaction after cataract surgery","volume":"42","author":"Szak\u00e1ts","year":"2017","journal-title":"Curr Eye Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.sjopt.2018.10.009","article-title":"Incidence and pattern of dry eye after cataract surgery","volume":"33","author":"Ishrat","year":"2019","journal-title":"Saudi J Ophthalmol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.3980\/j.issn.1672-5123.2016.10.02","article-title":"The course of dry eye following phacoemulsification and manual-SICS: a prospective study based on Indian scenario","volume":"16","author":"Dasgupta","year":"2016","journal-title":"Int Eye Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1097\/ICO.0000000000001491","article-title":"Epidemiology of persistent dry eye-like symptoms after cataract surgery","volume":"37","author":"Iglesias","year":"2018","journal-title":"Cornea"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1007\/s40123-022-00513-y","article-title":"Prevalence and characteristics of dry eye disease after cataract surgery: a systematic review and Meta-analysis","volume":"11","author":"Miura","year":"2022","journal-title":"Ophthalmol Ther"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"472","DOI":"10.4103\/0974-9233.151871","article-title":"Dry eye following phacoemulsification surgery and its relation to associated intraoperative risk factors","volume":"22","author":"Sahu","year":"2015","journal-title":"Middle East Afr J Ophthalmol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e78657","DOI":"10.1371\/journal.pone.0078657","article-title":"Incidence and pattern of dry eye after cataract surgery","volume":"8","author":"Kasetsuwan","year":"2013","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/ICU.0000000000000227","article-title":"Mechanisms and management of dry eye in cataract surgery patients","volume":"27","author":"Sutu","year":"2016","journal-title":"Curr Opin Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/ICU.0000000000001024","article-title":"Cataract surgery in setting of ocular surface disease","volume":"35","author":"Sarnicola","year":"2024","journal-title":"Curr Opin Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/ICU.0000000000000814","article-title":"Optimizing the ocular surface prior to cataract surgery","volume":"33","author":"He","year":"2022","journal-title":"Curr Opin Ophthalmol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s10384-012-0117-8","article-title":"Changes in the tear film and ocular surface after cataract surgery","volume":"56","author":"Oh","year":"2012","journal-title":"Jpn J Ophthalmol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1111\/j.1475-1313.2008.00539.x","article-title":"Changes in corneal sensitivity and tear physiology after phacoemulsification","volume":"28","author":"Khanal","year":"2008","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref20","first-page":"302","article-title":"Corneal sensitivity after surgery","volume":"102","author":"Lyne","year":"1962","journal-title":"Trans Ophthalmol Soc UK"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"978","DOI":"10.3390\/ijms18050978","article-title":"Goblet cells contribute to ocular surface immune tolerance-implications for dry eye disease","volume":"18","author":"Barbosa","year":"2017","journal-title":"Int J Mol Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1001\/archopht.1983.01040020286025","article-title":"Goblet cell density in ocular surface disease. A better indicator than tear mucin","volume":"101","author":"Kinoshita","year":"1983","journal-title":"Arch Ophthalmol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1345","DOI":"10.1007\/s10792-018-0953-8","article-title":"Changes in ocular surface status after phacoemulsification in patients with senile cataract","volume":"39","author":"Kohli","year":"2019","journal-title":"Int Ophthalmol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1932","DOI":"10.3390\/life12111932","article-title":"Efficacy of topical administration of corticosteroids for the management of dry eye disease: systematic review and meta-analysis","volume":"12","author":"Prinz","year":"2022","journal-title":"Life"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.ajo.2017.06.016","article-title":"Conjunctival goblet cell density following cataract surgery with diclofenac versus diclofenac and Rebamipide: a randomized trial","volume":"181","author":"Kato","year":"2017","journal-title":"Am J Ophthalmol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1177\/1120672119896427","article-title":"Short-term changes in ocular surface signs and symptoms after phacoemulsification","volume":"30","author":"Zamora","year":"2020","journal-title":"Eur J Ophthalmol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s10792-018-0828-z","article-title":"Long-term impact of dry eye symptoms on vision-related quality of life after phacoemulsification surgery","volume":"39","author":"Xue","year":"2019","journal-title":"Int Ophthalmol"},{"key":"ref28","first-page":"274","article-title":"Tear film changes after phacoemulsification","volume":"38","author":"Liu","year":"2002","journal-title":"Zhonghua Yan Ke Za Zhi"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"211","DOI":"10.3390\/jcm8020211","article-title":"Discrepancies in persistent dry eye signs and symptoms in bilateral Pseudophakic patients","volume":"8","author":"Hanyuda","year":"2019","journal-title":"J Clin Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1272\/jnms.JNMS.2021_88-405","article-title":"Changes in tear Osmolarity after cataract surgery","volume":"88","author":"Igarashi","year":"2021","journal-title":"J Nippon Med Sch"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e0152460","DOI":"10.1371\/journal.pone.0152460","article-title":"Observation of influence of cataract surgery on the ocular surface","volume":"11","author":"Park","year":"2016","journal-title":"PLoS One"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1080\/08820538.2016.1208764","article-title":"Assessment of the tear film lipid layer thickness after cataract surgery","volume":"33","author":"Kim","year":"2018","journal-title":"Semin Ophthalmol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2019\/2737968","article-title":"Preoperative management of MGD alleviates the aggravation of MGD and dry eye induced by cataract surgery: a prospective","volume":"2019","author":"Song","year":"2019","journal-title":"Biomed Res Int"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1016\/j.ajo.2014.02.036","article-title":"Evaluation of dry eye and meibomian gland dysfunction after cataract surgery","volume":"157","author":"Han","year":"2014","journal-title":"Am J Ophthalmol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2614","DOI":"10.1016\/j.jcrs.2015.06.036","article-title":"Evaluation of dry eye after femtosecond laser-assisted cataract surgery","volume":"41","author":"Yu","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.18240\/ijo.2019.07.11","article-title":"Changes in ocular surface status and dry eye symptoms following femtosecond laser-assisted cataract surgery","volume":"12","author":"Ju","year":"2019","journal-title":"Int J Ophthalmol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"5073","DOI":"10.3892\/etm.2018.6862","article-title":"Effects of femtosecond laser-assisted cataract surgery on dry eye","volume":"16","author":"Shao","year":"2018","journal-title":"Exp Ther Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"3097","DOI":"10.1007\/s10792-020-01532-z","article-title":"Comparable effects on tear film parameters after femtosecond laser-assisted and conventional cataract surgery","volume":"40","author":"Schargus","year":"2020","journal-title":"Int Ophthalmol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e8940","DOI":"10.1097\/MD.0000000000008940","article-title":"The improvement of dry eye after cataract surgery by intraoperative using ophthalmic viscosurgical devices on the surface of cornea: the results of a consort-compliant randomized controlled trial","volume":"96","author":"He","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1007\/s10792-017-0590-7","article-title":"Hydroxypropyl methylcellulose 2% for dry eye prevention during phacoemulsification in senile and diabetic patients","volume":"38","author":"Yusufu","year":"2018","journal-title":"Int Ophthalmol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1097\/j.jcrs.0000000000000491","article-title":"Phase IV clinical study to evaluate the effects of an intracameral combined mydriatic and anesthetic agent and standard topical mydriatics and anesthetics on the ocular surface after cataract surgery","volume":"47","author":"Souki","year":"2021","journal-title":"J Cataract Refract Surg"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1097\/ICO.0b013e31812f67ca","article-title":"Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery","volume":"26","author":"Li","year":"2007","journal-title":"Cornea"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1136\/bjo.83.9.1019","article-title":"Microbial decontamination of human donor eyes with povidone-iodine: penetration, toxicity, and effectiveness","volume":"83","author":"Pels","year":"1999","journal-title":"Br J Ophthalmol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"3065","DOI":"10.1007\/s10792-021-01869-z","article-title":"Trehalose\/sodium hyaluronate eye drops in post-cataract ocular surface disorders","volume":"41","author":"Cagini","year":"2021","journal-title":"Int Ophthalmol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1699","DOI":"10.1016\/j.jcrs.2014.12.056","article-title":"Effect of a hyaluronic acid and carboxymethylcellulose ophthalmic solution on ocular comfort and tear-film instability after cataract surgery","volume":"41","author":"Mencucci","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1097\/ICO.0000000000001523","article-title":"Effects of lipid- versus sodium hyaluronate-containing eye drops on optical quality and ocular surface parameters as a function of the Meibomian gland dropout rate","volume":"37","author":"Mih\u00e1ltz","year":"2018","journal-title":"Cornea"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.ajo.2021.04.031","article-title":"Effects of lipiflow treatment prior to cataract surgery: a prospective, randomized, controlled study","volume":"230","author":"Park","year":"2021","journal-title":"Am J Ophthalmol"},{"key":"ref48","first-page":"100","article-title":"Systane and cataract surgery","volume":"51","author":"Stefan","year":"2007","journal-title":"Oftalmologia"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"3311","DOI":"10.2147\/OPTH.S377960","article-title":"Propylene glycol and Hydroxypropyl guar Nanoemulsion - safe and effective lubricant eye drops in the Management of dry eye Disease","volume":"16","author":"Srinivasan","year":"2022","journal-title":"Clin Ophthalmol"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"9124","DOI":"10.1038\/s41598-021-88589-7","article-title":"A randomised, prospective study of the effects of 3% diquafosol on ocular surface following cataract surgery","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"100063","DOI":"10.1016\/j.aopr.2022.100063","article-title":"The effect of 3% diquafosol on the improvement of ocular surface post cataract surgery: a meta-analysis for time of intervention","volume":"2","author":"Zhang","year":"2022","journal-title":"Adv Ophthalmol Pract Res"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.clae.2015.07.003","article-title":"Assessment of the effect of cyclosporine-a 0.05% emulsion on the ocular surface and corneal sensation following cataract surgery","volume":"39","author":"Hamada","year":"2016","journal-title":"Cont Lens Anterior Eye"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e0245329","DOI":"10.1371\/journal.pone.0245329","article-title":"Efficacy of 0.05% cyclosporine a on the lipid layer and meibomian glands after cataract surgery: a randomized, double-masked study","volume":"16","author":"Kang","year":"2021","journal-title":"PLoS One"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"18625","DOI":"10.1038\/s41598-023-44939-1","article-title":"Assessment of the eye surface and subjective symptoms after using 0.1% dexamethasone drops with and without preservatives in patients after cataract surgery","volume":"13","author":"Muzyka-Wo\u017aniak","year":"2023","journal-title":"Sci Rep"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12886-015-0058-3","article-title":"The course of dry eye after phacoemulsification surgery","volume":"15","author":"Cetinkaya","year":"2015","journal-title":"BMC Ophthalmol"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.2147\/OPTH.S120159","article-title":"The prospective health assessment of cataract patients' ocular surface (PHACO) study: the effect of dry eye","volume":"11","author":"Trattler","year":"2017","journal-title":"Clin Ophthalmol"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"649030","DOI":"10.3389\/fmed.2021.649030","article-title":"Dry eye and phacoemulsification cataract surgery: a systematic review and Meta-analysis","volume":"8","author":"Lu","year":"2021","journal-title":"Front Med"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jcrs.2006.09.016","article-title":"Profile of clear corneal cataract incisions demonstrated by ocular coherence tomography","volume":"33","author":"Fine","year":"2007","journal-title":"J Cataract Refract Surg"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1136\/bjophthalmol-2019-315747","article-title":"Modern approach to the treatment of dry eye, a complex multifactorial disease: a P.I.C.A.S.S.O. Board review","volume":"105","author":"Aragona","year":"2021","journal-title":"Br J Ophthalmol"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.jtos.2017.05.006","article-title":"TFOS DEWS II management and therapy report","volume":"15","author":"Jones","year":"2017","journal-title":"Ocul Surf"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"Cd015070","DOI":"10.1002\/14651858.CD015070.pub2","article-title":"Topical corticosteroids for dry eye","volume":"10","author":"Liu","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1097\/ICO.0b013e31814b1b19","article-title":"Impaired corneal wound healing associated with ketorolac 0.5% after uncomplicated extracapsular cataract extraction","volume":"26","author":"Arey","year":"2007","journal-title":"Cornea"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ajo.2023.09.027","article-title":"NSAIDs and corticosteroids for the postoperative Management of age-Related Cataract Surgery: a systematic review and Meta-analysis","volume":"260","author":"Haddad","year":"2024","journal-title":"Am J Ophthalmol"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"167","DOI":"10.3341\/kjo.2013.27.3.167","article-title":"The effect of topical cyclosporine 0.05% on dry eye after cataract surgery","volume":"27","author":"Chung","year":"2013","journal-title":"Korean J Ophthalmol"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/j.jfo.2019.03.032","article-title":"Management of dry eye disease to optimize cataract surgery outcomes: two tables for a daily clinical practice","volume":"42","author":"Labetoulle","year":"2019","journal-title":"J Fr Ophtalmol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1559323\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T05:20:37Z","timestamp":1755580837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1559323\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,19]]},"references-count":65,"alternative-id":["10.3389\/fmed.2025.1559323"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1559323","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,19]]},"article-number":"1559323"}}