A study recently published in Scientific Reports evaluated the impact of several risk factors on Fuchs’ endothelial corneal dystrophy (FECD).
Give me some background first.
As an age-related disease, FECD is complex and heterogeneous in genetics—leading to:
- Oxidative stress
- Auto(mito)phagy
- Unfolded protein response
- Mitochondrial dysfunction
- Cellular apoptosis
To note: Prior to this research, no study had specifically examined which environmental factors might accelerate symptoms and progression of this disease.
Thus, researchers sought to investigate a number of these factors.
Who was included in the study?
A total of 403 participants (aged 28-96) were assessed after undergoing review from the prospective FECD genetics Database of the Center for Ophthalmology from the University Hospital of Cologne.
Exclusion criteria included other eye conditions and any previous surgery.
What was measured?
The following demographic and clinical criteria were observed as possible risk factors:
- Age of patients
- Age of diagnosis
- Gender
- Best spectacle-corrected visual acuity (BSCVA)
- Central corneal thickness (CCT)
- Krachmer grading based on slit-lamp exam
- A severity grading system for FECD
- Presence of diabetes mellitus (DM)
- Body mass index (BMI)
- Smoking behavior
Statistical analysis was then performed on this patient data.
Findings?
According to the study authors, four important conclusions were drawn from the data:
- Smoking had a negative impact on the modified Krachmer grade, displaying an effect on the development of FECD.
- The age of onset of FECD significantly correlated with the degree of obesity.
- The comorbidity DM had a significant impact on the modified Krachmer grade.
- FECD had a greater incidence in women, who were predominantly affected postmenopausal.
Of the 403 participants, 239 (59.3%) were women compared to 164 (40.7%) men. The median age of the patients was 70.0 ± 10.32.
Tell me more.
The key difference between the “normal,” “overweight,” and “obese” BMIs was a significantly different age at FECD diagnosis.
Plus: A BMI value of <30 was associated with earlier onset FECD (average age 64.40±12.31 years), compared to that of ≥ 30 (average age 58.59±15.06 years).
Expert opinion?
Per the study authors: “Since the vast majority of DM patients in our study suffer from DM type II, the metabolically associated type, we assume that metabolic changes contribute to the onset of FECD”.
They added that both smoking and DM were found to be risk factors for the development of more severe FECD, and “we could show for the first time that obese individuals develop FECD significantly earlier than non-obese individuals.”
I’m sensing a but …
However, they noted that, “The specific pathophysiology of how DM influences FECD remains unknown,” the authors concluded.
Take home.
Overall, this research demonstrated an association between age of FECD diagnosis and BMI levels, potentially indicating a role of glucose metabolism and the influence of estrogens in the development of the disease.
The authors concluded: “Further investigation of these potential risk factors would be of value, as they could be influenced by diet or medication.”