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Fuchs' Dystrophy and Chronic Optic Neuritis
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Fuchs' Dystrophy and Chronic Optic Neuritis

Good afternoon,
I am looking for some coping strategies with my FD and Optic neuritis.  I am a 41-year-old woman and have had FD for 22 years. My pachymetry is in the 750-780 range in each eye.  To complicate the situation, I have chronic optic neuritis in my right eye for which I occasionally receive solu-medrol ivs.  Due to presnidone use, I have cataracts in each eye. My vision is diminished in my right eye with a cupped optic nerve and a pupillary defect from the neuritis.  My current medications are muro drops, muro ointment, fml drops, and bacitracin ointment.

At this time, I am unable to read my computer, or anything else, for approximately five-six hours after waking. My halos and light  spikiness  last throughout the day.  A vital concern is that for many hours, I cannot look people directly in their faces; it is just too painful.  In addition, my eyes constantly feel like they have sand in them and become quite red and watery.

What can I do  to be able to ready my computer, drive, and talk to people? I need to get through my mornings much better than I currently am.  I am a high school teacher and mother of three.

Thanks for your help,
m
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I would get at least two different opinions from corneal/cataract Eye MD surgeons about the benefits of cataract removal and/or corneal Fuchs surgery.

You should also consider seeing a neuro-ophthalmologist. You may already be doing so. Get his/her opinion re cataract/corneal surgery. Any reduction of your vision due to optic nerve damage will not improve with cataract surgery.

You can find specialized Eye MD s at www.aao.org

PLEASE NOTE: There is a new corneal operation called by the acronym DSAEK which is MUCH better and safer than a corneal transplant. It is really an endothelial cell transplant. Not all cornea surgeons have learned how to do this. Ask the cornea Eye MDs on the phone or in person whether they can do DSAEK.

This is a recent post on Fuchs, there is a wealth of material on optic neuritis and cataracts which you can access with the search, archives and health topic features on this page.

JCH III MD

There is no exact definition of how many guttatta it takes to diagnosis Fuchs' Endothelial Corneal Dystrophy. Some guttatta are part of aging and do not ever become a problem. Two tests that are often helpful are corneal endothelial cell counts (the number decreases as the disease develops and progresses) and corneal pachymetry (corneal thickness) the thickness increasing as the disease develops and progresses. Family history is useful as many cases of Fuchs' are hereditary (affecting females more than males). Guttata are 'bumps' that develop on the back of the cornea when there are not enough endothelial cells to cover it. These cells are very important as they pump fluid out of the cornea and into the anterior chamber of the eye. The cornea is hydrophilic (water loving) like a sponge. When it swells and gets thicker it starts to become cloudy and blur the vision. When this happens and the impairment is severed than a corneal transplant is indicated. Recently a new operation for decompensated Fuchs' dystrophy called DSEAK (Descemet's membrane epithelial automated keratoplasty) has dramatically speeded the healing, safety and results over full thickness penetrating keratoplasty. Corneal endothelial cells do not multiply or replace themselves when damaged or cell death occurs.

Cataract surgery will not cause Fuchs' dystrophy but cataract surgery (or for that matter any surgery inside the eye) will stress the cornea and in severe Fuchs' could be the final straw that causes the cornea to compensate.

Your doctor is absolutely correct. In my patients with progressive Fuchs's dystrophy I recommend cataract surgery SOONER rather than later because the advanced, "hard" cataract will put much more stress and strain on the cornea endothelium than a moderately firm or softer cataract. Fuchs' dystrophy can decompensate on its own without any surgery taking place or any cataract in the eye.

It would be helpful to know if your mother's problem with her eye's was Fuchs' dystrophy. It is unusual for Fuchs' to cause an eye to be removed, so there's a good chance she had something else.

I would go ahead and have the cataract surgery when you vision starts to be a moderate problem for you and the cataract is the cause. By using the endothelial cell count and corneal thickness, your ophthalmologist can give you a reasonable risk of the cornea being able to stand your cataract surgery.

Good luck, new cataract surgical techniques are much, much more gentle on the eye than techniques used in the past.

JCH MD
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