Enhancing Diagnostic Precision in Fuchs Dystrophy: Comparative Evaluation of REVO HR and FC130 OCT Systems

Purpose: To compare the diagnostic performance of two anterior segment optical coherence tomography devices, REVO FC130 and REVO HR, in patients with Fuchs endothelial corneal dystrophy (FECD). Methods: This prospective cross-sectional study included 33 patients with FECD. Each patient was imaged with both devices. Eleven corneal features were graded independently by two evaluators. A third grader resolved disagreements. Agreement between graders and between devices was quantified by calculating the proportion of concordant assessments, including agreement for both detected and non-detected features, with corresponding 95% confidence intervals. Results: REVO HR provided better visualization of key corneal structures, including Descemet's membrane, Bowman's layer, and hyperreflective basal changes. Hyperreflective basal features were detected 11 times more often with REVO HR. Bowman's layer was identified 2.06 times more frequently with REVO HR compared to REVO FC130. Interoperator agreement was high for REVO HR (PropOverall ≥ 0.97 in 10 of 11 features). FC130 showed lower and more variable agreement, especially in low-contrast regions. Interdevice comparisons indicated systematic differences in detection capability. Conclusions: REVO HR showed higher sensitivity and reproducibility in detecting corneal microstructural changes in FECD. Improved image resolution allows better identification of subtle abnormalities, which may support more accurate disease staging and better timing of surgical intervention. For follow-up, the same OCT device should be used consistently. Translational Relevance: This study demonstrates that improved OCT resolution enhances detection of corneal microstructural abnormalities in Fuchs endothelial corneal dystrophy, improving diagnostic precision, disease staging, and clinical decision-making in routine clinical practice.