Does Fuch's get better over time?

[rayr]

About a year and a half ago, overnight, I developed intermittent double Double vision in both eyes. I went to 3 different eye doctors. The first said cataracts and referred me to a cataract surgeon. The second said I need new glasses which didn't help. The cataract surgeon said Fuchs's Cornea Dystrophy. He measured cornea thickness 630 right, 645 left,
cornea pressure Pressure 17 R 15 L, Guttata grade 3 plus, cell count not measured.  He said I would probably need a cornea replacement with in 2 years.  He refered me to a cornea surgeon.  

I saw her a year ago.  She measured corneal thickness of 656 and 679.  She did not do a cell count (her light bulb was burned out).  She said a would probably need a cornea replacement with in 5 years.

We moved to a different location so I recently went to another corneal surgeon.  90% of the time my vision is 20/20.  The rest of the time it can be as bad as 20/60.  He measured cornea thickness of 631 and 660.  Cell count was 2457 and 2183.   Guttata grade 1 plus.  From my understanding that is a healthy cell count for a 69 YO but a  thickness somewhat above average.  He said I will probably never need a cornea replacement and none of my vision problems are due to Fuch's.  He would like to see me back in a year.

I would like to believe the last surgeon.  Is my faith misplaced?  Are these differences of opinions common?  Does Fuch's get better over time?

Thanks

Ray

[Michael J Kutryb, MD]

Fuch's definitely does not get better.  In my experience it is extremely important to actually count and look at the cells.  Corneal thickness can sometimes be naturally thicker and sometimes it is increased from corneal swelling due to worsening fuch's disease.  I suspect the truth in this situation lies somewhere between the corneal specialist and the last doctor.  I'm sorry that the corneal specialist didn't even have a working cell count machine. Your cell count sounds pretty good so that is very encouraging.  I would also want to see the actual scan and how many and how close together the guttata were.  Hopefully, you will never need a transplant.  If your vision corrects to 20/20 I'm really puzzled why you were sent to a corneal specialist anyway since we don't even start to think about corneal surgery until the vison is much, much worse.  Sounds like you have really received some conflicting stories but the last info was very encouraging.

MJK MD

[Michael J Kutryb, MD]

That is very impressive readout from the machine.  This doctor appears to have very nice equipment which the conreal specialist may want to look into.  So yes, your condition did not change, only the opinions.

[rayr]

Hi Dr. Kutryb,

Thanks for the helful reply.  If it would help here is the full report on one eye:

CD (Endotheial cell density) 2457,
AVE (Average cell size) 407,
SD (standard devation) 185,
MAX (maximum cell size)1068,
CV (coeff varia) 45,
MIN (minimum cell size) 36,
6A (% cells with 6 sides) 38,
NUM (# cells counted to determine CD) 42
PACHY (thickness) 660

First corneal surgeon wanted to monitor me every six months.  The last one wants to see me on an annual basis if nothing gets worse.  The last suggestions sounds reasonable to me, do you agree?

If I understand you the appearant improvement of my condition is more of a difference of opinion of the three surgeons than an actual change?  Also my cell count is very good and the cornea thickness may not be entirely explained by the Fuchs'?

In the case of my eye where I saw 5 doctors and got 3 distinct causes of my problem and 3 different opinions of the severity is better than my arm where I got 5 different opinions, all of which proved wrong when surgery revealed a torn rotator cuff.

Thanks

Ray