What is Fuchs’ dystrophy?
Fuchs’ dystrophy is a slow progressing disease that usually affects both eyes. It is slightly more common in women than in men. Although doctors often see early signs of Fuchs’ dystrophy in people in their 30s to 40s, the disease rarely affects vision until people reach their 50s and 60s. Fuchs’ dystrophy occurs when the cells in the back layer of your cornea (the clear front window of your eye) gradually stop functioning and lose the ability to pump-out excess fluid.
What causes Fuchs’ dystrophy?
Fuchs’ dystrophy has a strong genetic component. It is thought to have an autosomal-dominant pattern of inheritance, meaning that if one parent has Fuchs’ dystrophy the child has a 50% chance of having the disease. Little is known about environmental factors that might contribute to its development or why it is more common in women.
Early signs of Fuchs’ dystrophy:
- Blurry or hazy vision in the morning that gradually improves as the day goes on
- Glare and halos when looking at lights
- Sensitivity to light
- Fluctuating vision
- Sandy or gritty sensation when blinking
Signs of advanced Fuchs’ dystrophy:
- Blurriness or haziness that does not go away
- Severe visual impairment
- Pain from epithelial blisters
How is Fuchs’ dystrophy treated?
Fuchs’ dystrophy does not always progress to the point that surgical treatment is required. Early on, your doctor may prescribe hypertonic saline to dehydrate your cornea and clear your vision. A hairdryer held at arms length may also be used to dry out excess moisture.
Unfortunately, in a small percentage of cases, Fuchs’ dystrophy progresses to the point that acceptable vision can no longer be maintained or the pain becomes intolerable. In those cases surgical intervention is the next step.
The primary surgical treatment for advanced Fuchs’ dystrophy is a type of corneal transplant called Descemet’s membrane endothelial keratoplaty, or DMEK for short. In DMEK surgery the damaged endothelial layer is replaced with a donor while the healthy remaining layers are left untouched.
DMEK is favoured over DSAEK and traditional full-thickness corneal transplants because it has less graft rejection, a quicker visual recovery and a reduced need for postoperative topical steroids.
However, if there is significant corneal scarring, a traditional full-thickness corneal transplant is usually necessary. Full-thickness corneal transplants for Fuchs’ dystrophy have a high success rate, with over 85% remaining clear after 2 years.