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Sangita P Patel, Brendan Plotke, Alexandra Sima, Amy E Millen; Prevalence of and risk factors for Fuchs endothelial corneal dystrophy (FECD). Invest. Ophthalmol. Vis. Sci. 2019;60(9):3832.
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FECD, a common indication for corneal transplantation in the US, affects women twice as often as men. The basis for the sex disparity in FECD prevalence and underlying risk factors are not known. A repeat expansion in the TCF4 gene confers risk for FECD, but cannot explain the sex disparity. The purpose of this study was to determine the age and sex distribution of FECD prevalence and evaluate differences in risk factors between men and women. We hypothesize that lifetime estrogen exposure plays a role in FECD pathophysiology underlying the sex disparity in prevalence.
Study protocols were approved by the University at Buffalo IRB. Consecutive adult patients (age ≥18 yrs) presenting to a cornea clinic (SPP) were examined (start Aug 2016) for corneal endothelial guttae, the hallmark clinical finding of FECD. Guttae were graded (modified Krachmer scale) and ≥1 central gutta (grade 1) in at least one eye was considered FECD. Beginning June 2017, consecutive patients completed risk factor questionnaires. Statistical significance was calculated with unpaired student’s t-test.
The prevalence study had 402 patients (60.7% female). FECD prevalence was 37.3% in women and 29.1% in men. When analyzed by age, there were large sex differences in prevalence in the 50-59 (2-fold greater in female) and 80-99 (1.5 fold greater in male) year age groups. We compared risk factors for guttae (grade=0 vs ≥1) in men (n=62, grade=0; n =32, grade≥1) and women (n=96, grade=0; n =61, grade≥1) separately. The factors evaluated were height, weight, BMI, smoking, ages at menopause and menarche, and reproductive lifespan. No risk factors showed significant differences in men with and without FECD. However, women with FECD weighed significantly less at age 18 (mean±SD; 123.5±20.0 lbs) compared to those without FECD (137.0±34.3, p=0.006) and had lower BMI at age 18 (20.9±3.0) compared to women without FECD (23.2±5.8, p=0.006).
We found the greatest sex disparity in FECD prevalence in the 50-59 yr age group which corresponds to the menopausal transition for women. Height and weight, factors that varied significantly in women with and without FECD, are also known to correlate with estrogen levels. However, we did not find differences in reproductive history between women with and without FECD. These findings both support and refute our hypothesis that FECD pathophysiology is affected by estrogen.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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