Transcript Endothelial Dystrophy Association with Hyperopia

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 Group
Control Group
130 pts, 248 eyes
127 pts, 241 eyes
65.30 ± 12.64
59.16 ± 14.34
0.0014**
Visual Acuity (logMAR) 0.30 ± 0.36
(mean ± standard
deviation)
0.16 ± 0.25
<0.0001**
Visual Acuity
(Snellen)
20/40
20/30
Male:Female
27% : 73%
41% : 59%
Family History
1
0
Age (mean ± standard
deviation)
p-value
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
+0.60 ± 2.65
(prior to correction of myopic shift)
(mean ± standard deviation)
-0.52 ± 2.44
<0.001**
+0.65 ± 2.57
-0.42 ± 2.44
<0.001**
Percent hyperopic
61
(prior to correction of myopic shift)
41
<0.0001*
Percent hyperopic
(after correction of myopic shift)
42
<0.001*
Spherical Equivalent
(after correction of myopic shift)
(mean ± standard deviation)
64
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