Endothelial Dystrophy Association with Hyperopia

Glenn W. Thompson, M.D.Timothy P. Page, M.D.

Authors have no financial interest

Purpose• Compare the incidence of hyperopia, and

refractive error of patients with and without guttata and Fuchs’ dystrophy

• Pitts and Jay first described the association between Fuchs’ dystrophy and hyperopia in 19901

– Their Fuchs’ patients had MRx of +2.48 compared to -.31 for controls, which was statistically significant

– Fuchs’ patients also had shorter axial lengths and shallower anterior chambers

1. Pitts JF, Jay JL. The association of Fuchs’ corneal endothelial dystrophy with axial hypermetropia, shallow anterior chamber, and angle closure glaucoma. Br J Ophthalmol 1990:74:601-604.

Purpose Continued

• We wanted to specifically look at hyperopia related to the severity of Fuchs’ dystrophy– Stage I: cornea guttata without stromal edema– Stage II: cornea guttata with stromal edema – Stage III: stromal edema with epithelial edema

and bullae, which may lead to subepithelial fibrosis

Methods

• Study Population– Cases: 130 patients with 248 eyes– Controls: 127 patients with 241 eyes

• Outcome Measures– Age– Gender– Family history of corneal dystrophy– Refraction including a chart review for myopic or

hyperopic shifts– Visual acuity– Quantification of central corneal guttata– Presence of corneal edema

Exclusion Criteria

• Previous cataract surgery with IOL was excluded unless preoperative data was available

• History of refractive surgery including RK, PRK, and LASIK

• Aphakic patients • Significant opacification of the ocular

media preventing determination of refractive error

Demographic Data** p-value of Wilcoxon Two-Sample Test using the t Approximation

Study Group130 pts, 248 eyes

Control Group127 pts, 241 eyes

p-value

Age (mean ± standard deviation)

65.30 ± 12.64 59.16 ± 14.34 0.0014**

Visual Acuity (logMAR) (mean ± standard deviation)

0.30 ± 0.36 0.16 ± 0.25 <0.0001**

Visual Acuity(Snellen)

20/40 20/30

Male:Female 27% : 73% 41% : 59%

Family History 1 0

Results

• A statistically significant greater proportion of study group eyes had a hyperopic spherical equivalent than the control group eyes (p-value<0.0001).

• Mean spherical equivalent– Cases: +0.60 SD ± 2.65 – Controls: -0.52 SD ± 2.44 – p-value < 0.001

Refractive Results* p-value of Two-tailed Fisher’s Exact Test

** p-value of Wilcoxon Two-Sample Test using the t Approximation

Study Group Control Group p-value

Spherical Equivalent (prior to correction of myopic shift)

(mean ± standard deviation)

+0.60 ± 2.65 -0.52 ± 2.44 <0.001**

Spherical Equivalent (after correction of myopic shift)

(mean ± standard deviation)

+0.65 ± 2.57 -0.42 ± 2.44 <0.001**

Percent hyperopic(prior to correction of myopic shift)

61 41 <0.0001*

Percent hyperopic(after correction of myopic shift)

64 42 <0.001*

Fuchs’ Dystrophy Severity *p-value of Two-tailed Fisher’s Exact Test <0.0001

Proportion hyperopic (%)* Spherical Equivalent (mean ± standard deviation)

Stage I

138/216 (64) +0.67 ± 2.56

Stage II

17/28 (61) +0.70 ± 3.21

Stage III

3/4 (75) +1.81 ± 2.82

Conclusions

• There is a significant association between the incidence of hyperopia and both the presence and degree of Fuchs’ dystrophy

• This is a large study of a primarily Caucasian suburban population

• Limitations of this study include the unmatched case and control age and visual acuity