Corneal Aberrations and Layer-Specific Changes in Fuchs’ Dystrophy: A Scheimpflug and AS-OCT-Based Analysis
Dominika Szkodny, Adam Wylęgała, Patrycja Potrawa, Katarzyna Kryszan, Arkadiusz Chalecki, Edward WylęgałaPurpose:
To investigate the relationship between layer-specific corneal structural changes and optical aberrations in Fuchs Endothelial Corneal Dystrophy (FECD), using Scheimpflug imaging and anterior segment optical coherence tomography (AS-OCT).
Setting:
Academic tertiary referral center.
Design:
Prospective, cross-sectional observational study.
Methods:
A total of 130 eyes (70 FECD, 60 controls) underwent high-resolution imaging using Pentacam AXL Wave and REVO HR OCT. Parameters measured included corneal thickness, Descemet’s membrane thickness, epithelial thickness, keratometry, densitometry, and wavefront aberrations. Correlation and multiple regression analyses were performed. Principal component analysis (PCA) identified major structural and optical contributors to visual quality.
Results:
Anterior higher-order aberrations (HOAs) significantly correlated with Kmax, anterior densitometry, and Descemet’s membrane thickness. Posterior HOAs correlated with central corneal thickness and posterior densitometry. Regression models identified Kmax and trefoil components as significant predictors of posterior HOAs. PCA revealed anterior HOAs, stromal haze, and optical degradation as dominant contributors to visual decline. These features varied with FECD grade and inversely correlated with best-corrected visual acuity (BCVA).
Conclusions:
Corneal aberrations in FECD are driven by layer-specific structural changes, notably anterior stromal haze and Descemet’s membrane thickening. These precede clinical edema and contribute to early visual impairment. Combined AS-OCT and aberrometry improve disease staging and surgical planning.