Vision and Quality of Life in Fuchs' Endothelial Dystrophy Using a Prototype Aberrometer: A Cross-Sectional Study

Fuchs' endothelial corneal dystrophy (FECD) is a progressive disease that affects vision and quality of life (QoL). While best distance-corrected visual acuity (BDCVA) is commonly used to assess visual function, the role of optical aberrations and high-resolution imaging in explaining patient-reported outcomes remains unclear. This study aims to evaluate how clinical, optical, and QoL parameters interrelate in patients with FECD.

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.