Factors Influencing Visual Acuity in Fuchs' Endothelial Corneal Dystrophy.

Significance: In eyes with mild Fuchs' endothelial corneal dystrophy without significant corneal edema, objective scattering index has the strongest influence on distance visual acuity, followed by the anterior corneal densitometry. Our findings suggest that distance visual acuity deteriorates in eyes with higher forward light scatter.

Purpose: To evaluate the factors affecting distance visual acuity in patients with Fuchs' endothelial corneal dystrophy.

Methods: This retrospective study comprised 31 eyes of 31 patients with mild Fuchs' dystrophy without corneal edema and 25 eyes of 25 age-matched healthy subjects. Stepwise multiple regression analysis was used to assess the relationship between distance acuity with age, sex, forward light scatter, corneal backward scatter, anterior and posterior corneal higher-order aberrations, endothelial cell density, central corneal thickness, and corneal astigmatism.

Results: The forward light scatter, corneal backward scatter, and corneal higher-order aberrations were significantly larger in the Fuchs' dystrophy group than those in the control group (P ≤ .004). In a univariate analysis, with higher forward light scatter, anterior corneal backward scatter, corneal higher-order aberrations, and age, the distance acuity significantly deteriorated in eyes with Fuchs' dystrophy. In a multiple linear regression analysis, explanatory variables relevant to the distance acuity were the forward light scatter (P < .001, partial regression coefficient B = 0.035) and anterior corneal backward scatter (P = 0.2, B = 0.008) (adjusted R = 0.694).

Conclusions: Eyes with higher light scatter, especially forward light scattering, showed deteriorated visual acuity. Results suggest that forward light scatter and corneal backward scatter play a more important role in visual performance than corneal higher-order aberrations in Fuchs' endothelial corneal dystrophy.