Structural correlates of multidimensional visual dysfunction in Fuchs endothelial corneal dystrophy

Purpose To characterize the relationships between corneal morphological features and multiple domains of visual function in Fuchs endothelial corneal dystrophy (FECD), and to identify tomographic parameters reflecting functionally meaningful visual impairment.Study design Retrospective cross-sectional comparative study.Methods This study included 115 eyes with FECD and 85 control eyes. Assessments comprised best-corrected visual acuity, contrast sensitivity with and without glare, straylight, Scheimpflug tomography, anterior segment optical coherence tomography, and the Visual Function and Corneal Health Status questionnaire. The area under the log contrast sensitivity function (AULCSF) was calculated from five spatial frequencies. Associations between corneal parameters and AULCSF were examined using ordinary least squares regression and linear mixed-effects models with patient-level random intercepts.Results FECD eyes showed reduced contrast sensitivity at all spatial frequencies after correction and increased straylight. Higher-order aberrations were greater in FECD eyes (0.70 ± 0.52 µm vs. 0.51 ± 0.30 µm, PConclusion Visual impairment in FECD is domain-specific. Contrast sensitivity and straylight were more closely associated with localized corneal irregularity, pachymetric asymmetry, and higher-order aberrations than with global corneal edema. These findings indicate that visual dysfunction reflects multiple localized and asymmetric corneal changes, with no single dominant tomographic marker.