Fuchs’ endothelial corneal dystrophy (FECD) is a somewhat rare, often genetic disorder that can lead to vision loss. Without early intervention, these patients can progress toward severe, irreversible visual disabilities. However, not every FECD patient requires the same treatments to preserve their sight. If doctors could quantify the driving factors of patients’ specific visual disability, it would help identify which patients are more likely to benefit from treatments such as endothelial keratoplasty that can address specific sources of visual disability. A new study published in the journal Cornea proposes a methodology to identify the best candidates for endothelial keratoplasty.

The investigators sought to assess morphological and optical determinants of visual disability in participants with advanced FECD using a specific visual disability instrument, the Visual Function and Corneal Health Status (V-FUCHS). The team looked at 100 cases of clinically advanced FECD and no other vision-limiting pathologies. The investigators calculated factors such as glare, acuity and Scheimpflug imaging (which assessed corneal morphology and optics).

They found that the more posterior corneal backscatter present, the greater the patients’ visual disabilities. Other morphological and optical factors such as anterior corneal backscatter, higher-order aberrations or edematous surface changes were not even empirical contributors to visual disability. Based on this, the team suggests surgical removal of the backscatter sources will improve visual disability caused by the condition.

“A comprehensive approach to staging FECD in clinical practice should include an assessment of morphological changes, particularly backscatter because of its effect on visual disability,” the report adds. “Such an approach will ultimately help shared decision-making from identifying the best candidates for endothelial keratoplasty.”

Wacker K, Grewing V, Fritz M, et al. Morphological and optical determinants of visual disability in fuchs endothelial corneal dystrophy. Cornea. November 7, 2019. [Epub ahead of print].