Association between subjective symptoms and severity in patients with Fuchs endothelial corneal dystrophy

To investigate the association between subjective symptoms and severity in patients with Fuchs endothelial corneal dystrophy (FECD).

Observational case series.

This study included patients with FECD registered in the Japanese National FECD registry with recorded subjective symptoms, including morning blur, ocular pain, visual disturbance, and glare. Severity assessments included central corneal thickness (CCT) and modified Krachmer grading using the more severely affected eye with greater CCT for each patient. The area under the curve (AUC) was used to evaluate the predictive ability of subjective symptoms based on disease severity.

This study included 137 cases (mean age: 69±11 years; men, n=32) with subjective symptom records. The threshold values of CCT for predicting subjective symptoms based on the Youden index were 623 µm for morning blur compared to that at night (AUC, 0.76), 653 µm for ocular pain (AUC, 0.79), 623 µm for visual disturbance (AUC, 0.69), and 581 µm for glare (AUC, 0.60). The threshold values of the modified Krachmer grading for predicting subjective symptoms were grade 5 for morning blur compared to that at night (AUC, 0.85), and grade 6 for ocular pain (AUC, 0.79), grade 5 for visual disturbance (AUC, 0.72), and grade 4 for glare (AUC, 0.70).

The predictive ability of subjective symptoms based on disease severity in patients with FECD was relatively high using the modified Krachmer grading. The severity threshold for each subjective symptom was considered helpful in deciding on interventional treatment.