Association of Clinical Measures and Characteristics of Microbial Keratitis with Patient-Reported Visual Function

To investigate the association between clinical findings and vision-related quality of life in patients with microbial keratitis (MK) in the United States.

Data from a prospective cohort of individuals with newly diagnosed MK were obtained at baseline and 90 days, including demographics, best-corrected visual acuity (BCVA), morphology, infection type, and the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Spearman correlations (rs) were used to assess associations between clinical measures and VFQ-25 scores; group differences were tested using Wilcoxon tests with Holm adjustment. Primary outcomes were 90-day VFQ-25 composite and subscale scores.

Seventy-nine participants (mean age: 53.6 ± 18.0 years, 47.4% male) completed the VFQ-25 with a mean composite score of 72.4 ± 23.1. Lower composite scores were associated with worse baseline affected-eye BCVA (rs = -0.44, P = 0.0027) and fluffy infiltrate (median 64.6 vs. 83.1, P = 0.018). At 90 days, lower scores were associated with worse affected-eye BCVA (rs = -0.68, P < 0.0001), worse better-eye BCVA (rs = -0.42, P = 0.006), persistent epithelial defect (36.1 vs. 83.1, P = 0.0098), persistent stromal infiltrate (42.0 vs. 83.1, P = 0.0240), and lack of healing (42.0 vs. 83.3, P < 0.0001). Worse 90-day affected-eye BCVA was associated with lower subscale scores for general vision, ocular pain, mental health, role difficulties, and driving (all P ≤ 0.0005). VFQ-25 scores did not differ by infection type (P = 1.0000).

Vision-related impairment in patients with MK is associated not only with BCVA but also with clinical markers of disease activity and healing, including persistent epithelial defect, stromal infiltrate, and nonhealed status. These findings suggest that functional impairment is related to factors beyond visual acuity.