VISION AND QUALITY OF LIFE IN FUCHS' ENDOTHELIAL DYSTROPHY USING A PROTOTYPE ABERROMETER

This study aims to evaluate how clinical, optical, and quality of life parameters interrelate in patients with Fuchs' endothelial corneal dystrophy.

This is a prospective, cross-sectional study. Participants were recruited consecutively between September 2022 and June 2023 at Fundación Jiménez Díaz Hospital (Madrid, Spain). This methodology adheres to the principles of the Helsinki Declaration; informed consent was obtained from all participants, and the protocol was approved by the Hospital Institutional Ethics Committee.

Prospective, cross-sectional study. Patients underwent ophthalmic evaluation including best distance-corrected BDCVA, refraction, central corneal thickness, endothelial cell density (ECD), and aberrometry using a high-resolution device. FECD severity was clinically graded (modified-Krachmer scale). Eyes were classified by lens status and presence of edema, pigment, or fibrosis. Quality of life was assessed using the NEI Visual Function Questionnaire (VFQ-25). Correlations were analyzed using univariate tests and multivariate regression.

Eyes exhibiting corneal edema detected by slit-lamp examination had significantly lower BDCVA compared to those without edema (mean difference 0.2 [95% CI: 0.08-0.32], adjusted p<0.001). Eyes with fibrosis also had worse visual acuity compared to those without (mean difference 0.137 [95% CI: 0.02-0.26], adjusted p=0.01). The Fuchs' grading scale showed strong correlation with BDCVA (r=-0.68, p<0.001) and moderate correlation with advanced wavefront metrics (RMS; r=0.3, p<0.001). VFQ-25 total score had the strongest correlation with the worst eye's visual acuity (r=0.42, p<0.001). Incorporating additional variables or more complex models did not significantly enhance prediction.

Worse-eye BDCVA correlates with patient-reported quality of life in FECD; however, adding high-resolution optical metrics (eg, wavefront/HPFM) did not meaningfully improve explanatory or predictive performance beyond simple clinical variables. These findings highlight a current gap: advanced optical metrics are not yet sufficient to reliably predict the subjective patient experience. Any conclusions from this study should be considered highly preliminary pending confirmation by further research.