Abstract
Purpose :
To determine risk factors in patients with Fuchs’ endothelial corneal dystrophy using a newly-developed questionnaire.
Methods :
We developed an instrument to assess Fuchs’ dystrophy-specific medical history and lifestyle risk factors including obesity, alcohol use, smoking, and sun exposure. After pretesting the instrument, the final instrument was completed by a prospective cohort of participants with Fuchs’ dystrophy and indication for endothelial keratoplasty. On slit-lamp biomicroscopy, all participants underwent modified Krachmer grading to determine confluence of guttae and corneal edema. Poisson regression models with robust standard errors were used to determine age- and sex-adjusted prevalence ratios of visible corneal edema (Krachmer grade 6) in the participant’s first study eye.
Results :
Among 375 study participants, 187 women and 120 men completed the instrument, (response 82%); 11 (3%) were deceased, 27 (7%) declined participation, and 30 (8%) did not respond. Mean age was 68 years in women and in men (mean difference, -0.7 years, 95% CI -2.9 to 1.4), indicating no sex difference in age at endothelial keratoplasty. Men were 1.42 times more likely to have corneal edema before endothelial keratoplasty compared to women (95% CI, 1.07-1.89). Participants reporting strict sun protection within minutes of exposure were 1.44 times more likely to have corneal edema compared to participants with one hour or more of unprotected sun exposure (95% CI, 1.07-1.92). Corneal edema was 1.26 times more likely for each 5 units increase in body mass index (BMI) at endothelial keratoplasty (95% CI, 1.11-1.43) but not for higher BMI at age 21 (prevalence ratio, 1.03; 95% CI, 0.75-1.42). Corneal edema was not different in smokers vs. non-smokers (prevalence ratio, 1.01; 95% CI, 0.75-1.36) and in frequent alcohol drinkers (≥2 days/week) vs. non-frequent drinkers (prevalence ratio, 1.07; 95% CI, 0.78-1.46).
Conclusions :
Despite a female predominance in keratoplasty, Fuchs’ dystrophy was clinically more severe in men than in women of the same age. Interventions to reduce obesity in adulthood may modify the risk of Fuchs’ dystrophy severity independent of age, sex, and weight in adolescence. A possible explanation of increased risk of corneal edema in participants with strict sun protection compared to those without might be that photosensitive skin types are more relevant than direct sun exposure.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.