Fuchs’ Patients May be Helped by Smoking Cessation, Moderating Salt Intake

The finding of significantly higher tobacco exposure in the FECD group compared with controls suggests the cumulative exposure of smoking on Fuchs’ may be a dose-response relationship. Photo: Christine Sindt, OD. Click image to enlarge.  Eye doctors who encounter a newly diagnosed patient with a corneal dystrophy—specifically, Fuchs’ endothelial corneal dystrophy (FECD)—may feel at a loss in how to proceed. Since there is no cure for Fuchs’, often, few therapeutic strategies remain as part of a management plan. In a new study published in Ophthalmology Science, researchers worked to clarify the relationship between FECD and systemic comorbidities, lifestyle factors and dietary patterns.The studied cohort included 100 people from the Cornea Service at Massachusetts Eye and Ear Infirmary: 50 FECD patients and 50 controls matched for age and sex. FECD was found to have higher rates of many different factors, which could impact the dystrophy when compared to controls, including higher associations with hyperlipidemia (74% vs. 50%), atrial fibrillation (26% vs. 8%), cumulative tobacco exposure (11.2 pack-years vs. 6.1 pack-years) and higher caloric intake (1,862 kcal vs. 1,463 kcal), respectively. Fuchs’ patients were also found to have reduced total and monounsaturated fat intakes when compared with controls, as well as increased intakes of sodium, zinc, manganese, selenium and whole grains.  The group of Fuchs’ patients generally had higher rates of cardiovascular diseases, with trends toward significance in congestive heart failure, hypertension and coronary artery disease, while significance was reached with hyperlipidemia and atrial fibrillation. What’s more, the authors of the study point out that the greater sodium intake also observed further suggests a cardiovascular phenotype, since excess sodium consumption is a cardiovascular risk factor. This link with Fuchs’ may be explained by a possible shared mechanism of corneal endothelial dysfunction and systemic vascular health, with sodium potentially exacerbating risks to both systemic and ocular health.Despite some of the higher rates of dietary measures seen in Fuchs’ patients, they did not show a consecutively higher carbohydrate or protein intake when compared with controls. Monounsaturated fats display conflicting evidence suggesting their association with protection from endothelial damage in cardiovascular disease. Also related to nutrition, the FECD group had higher rates of supplement use than controls, perhaps reflecting advice during clinical visits to adopt a healthy lifestyle.Smoking is already known to be linked with certain ocular diseases, and the current study only strengthens this idea. As the authors write, smoking likely adds to oxidative stress in Fuchs’ via increased free radical production and depletion of antioxidants in the bloodstream and ocular tissues. In turn, imbalance of these two can lead to exacerbated oxidative damage, thus resulting in apoptosis of endothelial cells, corneal guttae formation and higher Krachmer grading when adjusted for age.For clinicians, “these findings underscore the interconnected nature of systemic health and FECD pathophysiology, highlighting the potential for targeted interventions such as cardiovascular risk management, dietary modifications and smoking cessation to slow disease progression,” the authors contend.Click here for the journal source. Böhm M, Kaufman AR, Kahale F, et al. Fuchs endothelial corneal dystrophy associations with systemic disease, lifestyle and nutritional intake. Ophthalmol Sci. July 31, 2025. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.