Fuchs Endothelial Corneal Dystrophy Associations With Systemic Disease, Lifestyle, And Nutritional Intake

Fuchs endothelial corneal dystrophy (FECD) has a multifactorial pathophysiology, with contributions from both genetic and environmental factors. Systemic health influences on FECD pathophysiology remain incompletely understood. Prior research on FECD has focused primarily on genetic and environmental factors, with limited attention to the role of diet. This study aims to identify potential associations between FECD and systemic diseases, lifestyle factors, and nutritional intake.

Case-control study using a cross-sectional survey and retrospective chart review at the Cornea Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.

In this case-control study, 50 FECD patients and 50 age- and sex-matched controls were enrolled. A cross-sectional survey and retrospective chart review was conducted. FECD diagnosis was based on clinical criteria, and control patients had no history of FECD or corneal guttae. The survey included a validated semiquantitative food frequency questionnaire (SFFQ) and smoking and exercise questionnaire. Chart review examined demographics, FECD stage, medical history, and body mass index (BMI). Statistical analysis included Fisher exact tests and Mann-Whitney U tests, with nutritional factors adjusted for energy using the residual method. 

FECD patients exhibited higher rates of cardiovascular diseases compared to controls: hyperlipidemia (74% vs 50%, p=0.02), atrial fibrillation (26% vs 8%, p=0.03). Prevalence of diabetes was comparable between groups (10% vs 10%, p=1.0). No significant difference was observed for having ever smoked (56% vs 38%, p=0.11), but mean cumulative tobacco exposure (pack-years) was greater in the FECD group (11.2 vs 6.1, p=0.02). There were no differences in BMI (26.54 vs 26.17, p=0.88) or exercise activity (4.66 vs 4.56 hours/week, p=0.84). SFFQ computed levels for 222 nutritional items identified notable differences in the FECD group, including higher levels of sodium (2036.12 mg vs 436.22 mg, p=0.02) and total fat (71.00 g vs 67.00 g, p=0.04).

This study identifies significant associations between FECD and cardiovascular diseases, smoking behavior, and sodium intake, pointing to a potential implication for lifestyle interventions in disease management. The novel inclusion of dietary factors, an underexplored area in FECD research, highlights the potential for nutritional interventions to mitigate disease progression and the need for further research to confirm these associations, explore mechanistic pathways, and assess the impact of lifestyle modifications, such as smoking cessation and salt intake reduction. These findings underscore the importance of counseling FECD patients on modifiable risk factors to mitigate disease progression.