Vision and Quality of Life in Fuchs’ Endothelial Dystrophy Using a Prototype Aberrometer: A Cross-Sectional Study

Gonzalo Velarde-Rodriguez,1,2 Carolina Belda-Para,3 Miriam Velasco-Ocaña,3 Jose G Marichal-Hernandez,4 Ignacio Mahíllo-Fernández,2 Ignacio Jiménez-Alfaro,1,2 Katrin Wacker,5 Vito Romano,6 Jose Manuel Rodriguez-Ramos,3 Nicolas Alejandre-Alba1,2 1Ophthalmology Deparment, Hospital Fundación Jiménez Díaz, Madrid, Spain; 2Health Research Institute-Fundación Jiménez Díaz University Hospital, Madrid, Spain; 3Research and Development, Wooptix, La Laguna, Spain; 4ESIT, Industrial Engineering Department, La Laguna, Spain; 5Eye Center, University of Freiburg, Freiburg, Germany; 6Department of Medical and Surgical Specialties, Brescia University, Brescia, ItalyCorrespondence: Gonzalo Velarde-Rodriguez, Ophthalmology department, Hospital Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, Madrid, 28040, Spain, Email [email protected]: Fuchs’ endothelial corneal dystrophy (FECD) is a progressive disease that affects vision and quality of life (QoL). While best distance-corrected visual acuity (BDCVA) is commonly used to assess visual function, the role of optical aberrations and high-resolution imaging in explaining patient-reported outcomes remains unclear. This study aims to evaluate how clinical, optical, and QoL parameters interrelate in patients with FECD.Methods: Prospective, cross-sectional study. Patients underwent ophthalmic evaluation including best distance-corrected BDCVA, refraction, central corneal thickness, endothelial cell density (ECD), and aberrometry using a high-resolution device. FECD severity was clinically graded (modified-Krachmer scale). Eyes were classified by lens status and presence of edema, pigment, or fibrosis. Quality of life was assessed using the NEI Visual Function Questionnaire (VFQ-25). Correlations were analyzed using univariate tests and multivariate regression.Results: Eyes exhibiting corneal edema detected by slit-lamp examination had significantly lower BDCVA compared to those without edema (mean difference 0.2 [95% CI: 0.08– 0.32], adjusted p< 0.001). Eyes with fibrosis also had worse visual acuity compared to those without (mean difference 0.137 [95% CI: 0.02– 0.26], adjusted p=0.01). The Fuchs’ grading scale showed strong correlation with BDCVA (r=− 0.68, p< 0.001) and moderate correlation with advanced wavefront metrics (RMS; r=0.3, p< 0.001). VFQ-25 total score had the strongest correlation with the worst eye’s visual acuity (r=0.42, p< 0.001). Incorporating additional variables or more complex models did not significantly enhance prediction.Conclusion: Worse-eye BDCVA correlates with patient-reported quality of life in FECD; however, adding high-resolution optical metrics (eg, wavefront/HPFM) did not meaningfully improve explanatory or predictive performance beyond simple clinical variables. These findings highlight a current gap: advanced optical metrics are not yet sufficient to reliably predict the subjective patient experience. Any conclusions from this study should be considered highly preliminary pending confirmation by further research.Keywords: Fuchs endothelial corneal dystrophy, optics, cornea, quality of life, visual function