Quality of Vision in Patients With Fuchs Endothelial Dystrophy and After Descemet Stripping Endothelial Keratoplasty van der Meulen IJE, Patel SV, Lapid-Gortzak R, Nieuwendaal CP, McLaren JW, van den Berg TJTP. Quality of vision in patients with Fuchs endothelial dystrophy and after Descemet stripping endothelial keratoplasty. Arch Ophthalmol. Published online August 8, 2011. doi:10.1001/archophthalmol.2011.247. Copyright restrictions may apply

Introduction Patients with Fuchs dystrophy may have decreased quality of vision caused by increased forward light scatter in addition to decreased visual acuity. Straylight (disability glare) is a functional term that denotes scattered light falling on the retina as observed by the patient and is proportional to forward light scatter. This study evaluated the quality of vision (visual acuity and straylight) in patients with Fuchs dystrophy and the improvement in visual quality after Descemet stripping endothelial keratoplasty (DSEK). Copyright restrictions may apply

Methods Patients with phakic and pseudophakic eyes with Fuchs dystrophy were recruited at 2 centers: Observational case series: Academic Medical Center, Amsterdam, the Netherlands (99 eyes). Prospective interventional case series: Mayo Clinic, Rochester, Minnesota (48 eyes). Patients in the Mayo group were also examined at 1, 3, 6, and 12 months after DSEK. All these eyes were rendered pseudophakic during DSEK. Outcome measures: High-contrast corrected distance visual acuity (CDVA) using Early Treatment Diabetic Retinopathy Study protocol. Straylight using Oculus C-Quant straylight meter. Central corneal thickness using ultrasonic pachymeter. Copyright restrictions may apply

Methods Straylight of phakic eyes with Fuchs endothelial dystrophy was compared with that of age-matched normal eyes using 2-tailed unpaired t tests. Straylight of pseudophakic eyes with Fuchs endothelial dystrophy was compared with that of normal pseudophakic eyes using 2-tailed unpaired t tests. Correlations were examined by using the bivariate Pearson method or, when data were not normally distributed, the Spearman ρ coefficient. P < .05 was considered statistically significant. Copyright restrictions may apply

Results Eyes with Fuchs dystrophy had decreased CDVA and increased straylight compared with normal eyes. Younger patients were affected more by increased straylight than by decreased CDVA. Straylight and CDVA improved significantly at all postoperative examinations. Postoperative improvement in straylight was more predictable than that of CDVA and was correlated with preoperative straylight. Eyes with preoperative straylight higher than 1.33 logarithm of the straylight parameter (log[s]) consistently improved after DSEK. Copyright restrictions may apply

Results A B Copyright restrictions may apply Straylight as a function of age for the Amsterdam and Mayo patients with phakic (A) and pseudophakic (B) eyes and Fuchs endothelial dystrophy. Straylight was increased compared with normal eyes in patients of the same age (P < .01), especially in younger patients. The central black line represents average straylight in healthy phakic (A) and pseudophakic (B) eyes. The dotted lines represent ±0.2 log intervals. Copyright restrictions may apply

Visual Quality Before and After DSEK for Fuchs Endothelial Dystrophy Results Visual Quality Before and After DSEK for Fuchs Endothelial Dystrophy Copyright restrictions may apply

Results Postoperative improvement in straylight as a function of preoperative straylight values. After DSEK, straylight improved to approximately 1.35 log(s), regardless of preoperative straylight. As a consequence, postoperative improvement in straylight was correlated with preoperative straylight. The regression line (solid line) shows that eyes with preoperative straylight higher than 1.33 log(s) can be expected to improve after DSEK. Copyright restrictions may apply

Comment Straylight and CDVA are severely impaired in Fuchs dystrophy, and both improve significantly after DSEK. Younger patients with Fuchs dystrophy are affected more by increased straylight than by decreased visual acuity, and straylight improves more in younger eyes than in older eyes after DSEK. Postoperative improvement in straylight is associated with preoperative straylight more than 1.33 log(s). Straylight is easily measured in the clinic and could be a useful clinical metric to determine the timing of surgery, especially in young, symptomatic patients whose CDVA is close to 20/20. Copyright restrictions may apply

Contact Information If you have questions, please contact the corresponding author: Ivanka J. E. van der Meulen, MD, Department of Ophthalmology, A2 Room 123.1, Academic Medical Center, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands (i.j.vandermeulen@amc.uva.nl). Funding/Support This work was supported in part by Research to Prevent Blindness (an unrestricted grant to the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, and Dr Patel as an Olga Keith Wiess Special Scholar) and the Mayo Foundation, Rochester. Copyright restrictions may apply