You are here

Responses

Article menu
Download PDFPDF
Clinical science
Influence of corneal guttae and nuclear cataract on contrast sensitivity
Compose a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on: 27 January 2021
    Influence of corneal guttae and nuclear cataract on contrast sensitivity
    • Victor A Augustin, Ophthalmologist Department of Ophthalmology, University of Erlangen-Nuremberg, Erlangen, Germany
    • Other Contributors:
      • JM Weller, Consultant Ophthalmologist
      • FE Kruse, Professor, Ophthalmology
      • T Tourtas, Consultant Ophthalmologist

    Reply to the comment on: “Influence of corneal guttae and nuclear cataract on contrast sensitivity”

    We thank Sanjay V Patel for the comments. Patients with Fuchs endothelial corneal dystrophy (FECD) are known to have reduced contrast sensitivity due to corneal edema and guttae. Before the introduction of endothelial keratoplasty, penetrating keratoplasty had been performed mainly in patients with advanced FECD and clinically significant corneal edema. However, as endothelial keratoplasty procedures such as Descemet membrane endothelial keratoplasty can bring excellent visual acuity outcomes, surgery can be performed earlier and even in cases without any clinical corneal edema. Therefore, it has become even more important to detect the causes of visual impairment in patients with FECD. In our retrospective study, we enrolled FECD patients with >5 mm of confluent guttae and no corneal edema (modified Krachmer grade 5). When analyzed by Scheimpflug tomography, our FECD patients showed no difference in the central corneal thickness and corneal volume when compared to the control group of cataract patients without any corneal pathologies.1 Recently, Sun et al. presented a new method to detect subclinical corneal edema in patients with FECD.2,3 The authors analyzed three Scheimpflug tomography pachymetry map and posterior elevation map patterns to detect subclinical edema in FECD patients: loss of regular isopachs, displacement of the thinnest point of the cornea, and...

    Show More
    Conflict of Interest:
    None declared.
  • Published on: 19 September 2020
    Subclinical Corneal Edema and Contrast Sensitivity in Fuchs Endothelial Corneal Dystrophy
    • Sanjay V Patel, Cornea Surgeon & Professor of Ophthalmology Mayo Clinic, Rochester, MN, USA

    Eyes with Fuchs endothelial corneal dystrophy (FECD) are known to have reduced contrast vision from increased glare even if high-contrast acuity is not affected.1 In a retrospective study, Augustin and colleagues suggested that corneal guttae without edema contribute to decreased contrast sensitivity, and that such eyes would benefit from Descemet membrane endothelial keratoplasty (DMEK).2 The topic is important because it is unknown whether guttae in the absence of any corneal edema affect vision and therefore whether such eyes truly benefit from DMEK. The authors enrolled eyes with >5 mm of confluent guttae and without edema (modified Krachmer grade 5); however, they did not state their definition of “edema”. In FECD, when corneal edema is not clinically detectable by slit-lamp examination, it can be detected by Scheimpflug tomography.3 A recent study found evidence of subclinical corneal edema in 88% of eyes with FECD grade 5 and almost 40% of eyes with lesser grades of FECD.4 It is therefore highly likely that many of the FECD eyes examined by Augustin and colleagues did in fact have subclinical corneal edema, so can the authors examine the Scheimpflug tomograms of these eyes and report the contrast sensitivity results based on the presence or absence of subclinical edema? This is important because reduced contrast sensitivity might be caused by subclinical edema and not simply by “guttae without edema”, and cornea surgeons should not conclude that it is appr...

    Show More
    Conflict of Interest:
    None declared.