Fuchs' dystrophy

 

Fuch's Dystorphy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men. Although doctors can often see early signs of Fuchs' dystrophy in people in their 30s and 40s, the disease rarely affects vision until people reach their 50s and 60s.

Fuchs' dystrophy occurs when endothelial cells gradually deteriorate without any apparent reason. As more endothelial cells are lost over the years, the endothelium becomes less efficient at pumping water out of the stroma. This causes the cornea to swell and distort vision.

Eventually, the epithelium also takes on water, resulting in pain and severe visual impairment. Epithelial swelling damages vision by changing the cornea's normal curvature, and causing a sight-impairing haze to appear in the tissue. Epithelial swelling will also produce tiny blisters on the corneal surface. When these blisters burst, they are extremely painful.

At first, a person with Fuchs' dystrophy will awaken with blurred vision that will gradually clear during the day. This occurs because the cornea is normally thicker in the morning; it retains fluids during sleep that evaporate in the tear film while we are awake. As the disease worsens, this swelling will remain constant and reduce vision throughout the day.

 

When the disease interferes with daily activities, a person may need to consider having a corneal transplant to restore sight. The short-term success rate of corneal transplantation is quite good for people with Fuchs' Dystrophy However, some studies suggest that the long-term survival of the new cornea can be a problem.


Contact lenses

Contact lenses can reduce the oxygen supply to the cornea. Some corneas can't tolerate the reduced oxygen supply and manifest hypoxic stress by changes in the shape and size of indivdual endothelial cells. Specular Microscopy can detect these changes at an early stage so that either discontinuing the contact lenses or re-fitting to a more oxygen permeable lens can prevent permanent cell loss.

Specular microscopes are for specular endothelial analysis.The endothelium is the back layer of the cornea. The endothelium pumps fluid out of the cornea enabling the cornea to be clear. Endothelial dysfunction leads to corneal edema(swellling) and reduced vision and ultimately to corneal failure requiring transplantation.

The specular microscope at Liva Eye Center represents the latest in endothelial cell analysis, algorithms, and computer technology. Enhanced with auto-focus, auto-alignment, and auto-cell counting.

The microscope easily captures consistent, high quality images of the corneal endothelium that identifies the position of the cellular interface.

In addition, non-contact pachymetry(meaurement of corneal thickness) is performed at the same time image analysis of the corneal endothelium is aquired.

The assessment of the corneal endothelial cell layer, morphology of endothelial cells, and corneal pachymetry are all indicators of corneal health.

Normal Corneal Endothelium

Specular microscopy of a normal cornea. Note the compact, uniform hexagonal appearance of the endothelial cells.

 

Fuch's Disease

Fuchs endothelial dystrophy. The apparently empty spaces are occupied by guttate.