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Katrin Wacker, Keith Baratz, Katrina M. Kane, Sanjay V Patel; Association between optical properties and visual disability in Fuchs endothelial corneal dystrophy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5664.
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© ARVO (1962-2015); The Authors (2016-present)
Understanding patient symptoms in Fuchs endothelial corneal dystrophy (FECD) and patient-reported outcomes of endothelial keratoplasty might help determine when to intervene surgically. In this study, we examined relationships between optical and anatomical properties in FECD and patient-reported visual disability.
Thirty-two participants with FECD and 14 with normal corneas were graded clinically based on the presence of corneal guttae and edema (modified Krachmer grading), and cataract severity (LOCS III). Scores from the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and the Rasch model-based mean logit score of a visual disability instrument, Catquest-9SF, were correlated with best-corrected ETDRS visual acuity, straylight, corneal high-order aberrations, standardized anterior and posterior corneal backscatter, central corneal thickness, and effective endothelial cell density by using age- and lenticular-status-adjusted linear regression models.
VFQ-25 and Catquest scores were worse with higher grade of severity of FECD (both, p-trend <0.001). VFQ-25 composite scores were lower in moderate (grades 3 and 4; mean, 87; 95%CI, 80–93; n=8, p=0.031) and advanced FECD (grades 5 and 6; 78; 95%CI, 73–83; n=15, p<0.001) than normal (95; 95%CI, 90–100; n=14). Catquest-9SF scores were less negative (indicating more difficulty) in moderate (mean, -2.1; 95% CI, -1.2 to -2.2, p=0.012) and advanced (-1.7; 95%CI, -1.0 to -2.3, p=0.001) FECD compared to normal (-3.5; 95%CI, -2.8 to -4.2). In multivariable models, worse visual acuity and increased back surface total high-order aberrations were associated with worse mean Catquest scores (+0.7 logit per 10 letters decrease and per 0.1µm increase; R2=0.53, p<0.03), whereas there were no independent associations with VFQ-25 composite score. VFQ-25 domains for general vision, distance and near activities, dependency, and mental health were inversely associated with back surface total high-order aberrations.
Visual disability is impaired in moderate and advanced FECD compared to controls even when accounting for lenticular status. Catquest-9SF and specific domains of VFQ-25 are associated with degraded optical properties, and warrant further investigation as measures of patient-reported outcomes of surgical treatment for FECD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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