Peripheral-to-central ratio of Guttae: validity and reliability of an objective method to characterize severity of Fuchs endothelial corneal dystrophy

Rohan P. Bajaj, Michael J. Fliotsos, Tejus Pradeep, Allen O. Eghrari

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Common methods of measuring severity of Fuchs endothelial corneal dystrophy (FECD) are limited in objectivity, reliability, or start with a variable baseline that prevents distinguishing healthy from affected eyes. The aim of this study was to describe a method of grading FECD that overcomes these limitations. Methods: Fifteen patients with Fuchs endothelial corneal dystrophy were included in the study. Guttae were imaged with a slit lamp beam 8 mm tall; the bottom 4 mm half of each image was divided into two equally-sized sections. Guttae were counted by four independent graders blinded to disease severity scores. The peripheral:central guttae ratio was compared to modified Krachmer clinical severity scores. The peripheral:central guttae ratio was compared between mild (severity 0.5–3) versus moderate-to-severe (severity 4–5) disease. Receiver operating characteristics defined optimal ratio cutoffs for mild versus moderate-to-severe disease. Results: Increased peripheral guttae and peripheral:central guttae ratio correlated with Krachmer severity (p = 0.021 and p = 0.009, respectively). The difference between mild and moderate-to-severe cases for the peripheral:central guttae ratio was significant (p < 0.001). Inter-rater reliability of total guttae count was high (coefficient = 0.82, p < 0.001). A peripheral:central guttae ratio of 0.16 was the ideal cut-off point (area under the curve = 0.79, sensitivity = 0.78, and specificity = 0.80). Conclusion: In this pilot study, the peripheral:central ratio of guttae correlates with subjective clinical severity of Fuchs dystrophy. It starts at a common baseline, has good inter-rater reliability, does not require dilation, and can be conducted with a smartphone and slit-lamp.

Original languageEnglish (US)
Pages (from-to)685-690
Number of pages6
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume259
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Central-to-peripheral ratio
  • Cornea
  • Fuchs endothelial corneal dystrophy
  • Guttae
  • Smartphones

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Fingerprint

Dive into the research topics of 'Peripheral-to-central ratio of Guttae: validity and reliability of an objective method to characterize severity of Fuchs endothelial corneal dystrophy'. Together they form a unique fingerprint.

Cite this