Category: Eye Diseases

Blurry morning vision that clears up by midday is one of the classic early symptoms of Fuchs’ Corneal Dystrophy. If you’ve been told you have Fuchs’, or even just corneal guttae, you may have a lot of questions. What is Fuchs’ Corneal Dystrophy? How serious is the disease, and what treatment is available? In this guide, we’ll break down everything you need to know, from symptoms to diagnosis to treatment and low vision support so you can stay well informed on your eye health.

What is Fuchs’ Corneal Disease?

Fuchs’ Corneal Disease—also known as Fuchs’ Corneal Dystrophy, Fuchs’ Endothelial Dystrophy, or simply, Fuchs’—is a disease affecting the corneas of both eyes. The cornea is the clear, dome-shaped outer layer of the eye which covers the iris, pupil, and anterior chamber. A progressive disease, Fuchs’ Dystrophy specifically affects the endothelial cell layer, the cells responsible for pumping fluid out of the cornea to keep it clear. When these cells begin to fail, fluid builds up, the cornea swells, and vision becomes cloudy. Fuchs’ almost always affects both eyes, even if one eye is worse than the other.

Fuchs’ Disease: A Genetic Cause

Fuchs’ is genetic, meaning this is not something you caused. It is not related to screen use, eye strain, or anything you did wrong. Endothelial cells decline slowly, often over decades. Symptoms usually appear later in life around the 50s or 60s, though being diagnosed in your 20s, 30s, or 40s is increasingly common. We’re simply able to detect it earlier now, which allows for better long-term planning.

What are the Symptoms of Fuchs’ Disease?

The most common symptoms are:

• Blurred or hazy vision, especially in the morning
• Glare and halos around lights
• Vision that fluctuates throughout the day
• Pain or discomfort in more advanced stages of the disease

How is Fuchs’ Diagnosed?

The diagnosis is made clinically and does not require tissue samples or a biopsy. During the evaluation, doctors look at several factors, including:

• Guttae: These are tiny bumps on the back of the cornea that are an early sign of endothelial deterioration.
• Corneal thickness: The thickness of the cornea increases as fluid builds up in the cornea.
• Endothelial cell counts: Fuchs’ Disease causes endothelial cells to die; a cell count will indicate the stage of disease a person may be at.

How Serious Is Fuchs’ Disease?

Fuchs’ is a progressive condition, but its severity can vary from person to person. Some people live their entire lives with only mild Fuchs’ and never need surgery. Others progress to significant corneal swelling that interferes with reading, driving, and daily activities. In other words, this condition exists on a spectrum, and where you fall on that spectrum matters for proper treatment.

What is the Treatment for Fuchs’ Corneal Dystrophy?

Treatment for Fuchs’ is not one-size-fits-all. The condition progresses slowly–generally over decades–and the appropriate treatment depends on the stage of the condition and how much your daily life is affected.

Early Stage Fuchs’

Early treatment focuses on managing corneal swelling, not curing the disease. Hypertonic saline (salt or sodium chloride) drops or ointments may be used to reduce swelling and temporarily improve clarity. While saline drops help to relieve symptoms, they do not stop disease progression. Another morning evaporation strategy involves using a hair dryer on low to gently dry the cornea.

Advanced Fuchs’

When vision becomes consistently cloudy, surgery becomes the definitive treatment. In the past, surgery meant a full-thickness corneal transplant, which involved long recovery times and greater risk. Today, modern endothelial transplants—such as DMEK or DSAEK—have dramatically improved outcomes for patients with Fuchs’. These procedures replace only the damaged endothelial layer, leaving most of the cornea intact. Recovery following modern endothelial transplant is generally much faster and better tolerated than the older corneal surgeries. Many patients notice improvement within weeks, with continued visual refinement over several months.

It’s important to note that if you’ve been told you have guttae, that does not automatically mean you will need surgery. Guttae are early warning signs and a relatively common corneal finding. They do not guarantee progression, and some people may never progress to advanced disease.

As an additional note, many patients also have questions regarding Fuchs’ and cataracts. These conditions often occur together, as both are age-related. Cataract surgery places stress on endothelial cells, which can worsen corneal swelling in patients with Fuchs’. When appropriate, many patients with these coexisting conditions could benefit from combined procedures.

How Does Low Vision Care Fit In with Fuchs’ Corneal Dystrophy?

How does low vision care fit into all of this? This is something that doesn’t get talked about enough. Most people do very well after Fuchs’ surgery, but not everyone ends up with perfect vision. Some patients are left with glare, contrast loss, or other visual limitations that still affect daily life.

This is where low vision care comes in. At Midwest Low Vision, we help patients function better even when the eyes can’t be medically or surgically improved any further. If vision problems are still limiting you, it’s important to know there are options beyond “you just have to live with it.”

Conclusion

Fuchs’ Corneal Dystrophy is a progressive condition that affects vision differently for people. Understanding your condition, staying informed about treatment options, and seeking the right support are all key to protecting your vision for years to come. If you’d like to learn more, check out our video on this topic. And if you have questions about Fuchs’ Corneal Disease, or about low vision care, please reach out to us today.

Optic atrophy is the degeneration of the optic nerve that results in vision loss. For many people with this condition, this may mean having to give up activities they love, such as reading, doing crafts, or driving. Though there is no cure for optic atrophy, low vision care can help you regain functional vision to get back to the things you enjoy. This was the success story for Kathy, a Midwest Low Vision patient, who was able to turn optic atrophy from an obstacle into an opportunity.

What is Optic Atrophy?

Optic atrophy, or optic neuropathy, is a condition in which the optic nerve—the “cable” that carries visual information from the eye to the brain—begins to deteriorate. Atrophy of the optic nerve is not a disease in itself; rather, it is the result of long-term damage to nerve fibers from a variety of causes, such as glaucoma, tumors, trauma, or in Kathy’s case, a hereditary condition. This damage can lead to the loss of some, or even all, of the vision in the affected eye(s).

Symptoms of optic atrophy may include:

• Decreased visual acuity
• Peripheral vision loss
• Reduced color vision

These symptoms closely resemble those of other vision problems, so if you are experiencing any of these concerns, contact your eye doctor for an examination.

Management of optic neuropathy first begins with addressing the underlying cause of the condition. While treatment of the cause may prevent the atrophy from progressing, there is no cure to reverse the damage. Fortunately, low vision care may help you regain functional eyesight and improve quality of life.

Kathy’s Story: Seeking Answers

In 1998, Kathy’s eye doctor referred her to a specialist because her best-corrected vision was 20/40 in one eye and 20/50 in the other. Fast forward to 2012, and Kathy’s eyesight had worsened to 20/70 and 20/80. Though she didn’t know it at the time, her eyesight could be classified as low vision. Passed along to another specialist, and eventually to a neuro-ophthalmologist, Kathy learned through a blood test that she had a defect on her optic nerves and was officially diagnosed with dominant optic atrophy.

Looking for a Path Forward with Optic Atrophy

The optimism ended there, however, as Kathy “had a diagnosis but no course of action.” She learned there was no treatment to reverse her condition, and there was no way of knowing how her vision loss might progress. The only path forward was simply to monitor her vision and update her glasses as needed.

The next several years saw a diminished quality of life. Kathy relied on digital devices with large fonts, magnifiers, and large computer monitors to do her job. Hobbies like reading and crafting became difficult and less enjoyable. Though she had been able to drive during daytime hours, she finally stopped driving in 2021 due to growing anxiety about safety on the road.

Low Vision Care Brings Hope

Later in 2021, Kathy’s struggles changed when she ran across Midwest Low Vision in a YouTube video. Though she had never heard the term “low vision” before, she booked a free phone consultation with Holly, our Lead Low Vision technician, and then scheduled an appointment with Dr. Jarrod Long. She says of her experience, “I had little idea what to expect on my first visit. I have had some bad visits with eye doctors over the course of my life and hoped I didn’t have to get poked and prodded. Dr. Long ACTUALLY LISTENED to what I had to say and what my goals were… It was the most relaxed eye exam I ever had. I knew I had found someone who wanted to help me see the best that was possible for me.”

Reading Signs Across a Store

Kathy was fitted for two pairs of glasses—one for distance, and one for reading. In January of 2022, she received her distance glasses. “I could read signs across a store!” she stated, “ It really did open the world back up to me. I read the 20/40 line with clarity. I didn’t have to guess what was there.” One month later, she received her reading glasses. “I was able to hold my phone at a normal distance and read it instead of having it about six inches away from my face,” Kathy said. “The other thing that I have really enjoyed since getting the reading glasses is being able to read a menu in a restaurant without struggling, even if the lighting is not the best. In the past, I always had to use a magnifier on my phone to help with this.”

From Optic Atrophy to Bioptic Driver

Next, Kathy set her sights on returning to driving. “Driving was definitely important to me, and it would enable me to get back to work.”

With the help of the State of Indiana’s Vocational Rehabilitation (Voc Rehab) program, she began bioptic driver training in February 2023. “I had to drive in different situations, learning when to look through my bioptics to spot traffic lights, road signs, pedestrians, emergency vehicles, etc. I did a nighttime evaluation as well. I drove more in six weeks than I had driven in the past 18 months!”

By March, she passed her state driving test and became a licensed bioptic driver. “I’m now free to drive whenever I want. I no longer have daylight driving hours only. This opens my world back up in ways I didn’t think possible just a year ago.”

Low Vision Care for Optic Atrophy

Kathy’s story shows what’s possible—even with a serious diagnosis like optic neuropathy. States Dr. Long, “Her story is a success, but I think it could have been successful at an earlier stage. That’s why we share these stories—to change that for others.”

If you, or a patient of yours, are struggling with low vision, contact us today to see how we might be able to help.

 

When patients come to Midwest Low Vision, they’re often surprised to learn that one of our team members understands their challenges not just professionally—but personally. Holly, our ABO-certified, low vision technician, was diagnosed with Stargardt disease in her mid-20s. Living, and thriving, with low vision allows her to better understand her patients and offer support that comes from genuine understanding.

In this article, we take a look at what Stargardt disease is, how it affects vision, and what support is available. We’ll also hear some insight from Holly along the way.

What is Stargardt Disease?

Stargardt disease, also known as Stargardt macular dystrophy, is a genetic type of macular degeneration that affects central vision and causes progressive vision loss. While it is more common to hear about age-related macular degeneration (AMD), which occurs later in life, Stargardt disease generally affects children and adults younger than 20. For this reason, healthcare providers sometimes refer to it as juvenile macular dystrophy. In Holly’s case, she wasn’t diagnosed until she was 26 years old. “I had been told as a teenager that there was something wrong—we just didn’t know what. It wasn’t until well into my optometry career before I was officially diagnosed.”

When you have Stargardt disease, your body can’t properly break down and remove from your eye a fatty substance called lipofuscin. As a result, this material builds up in the macula, damaging cells responsible for sharp central vision, which leads to vision loss.

Symptoms of Stargardt Disease

Symptoms of Stargardt disease often begin in childhood or young adulthood, though some may not notice changes until later in life. Common symptoms  include:

• Blurred vision
• Gray or hazy spots in the center of your vision
• Sensitivity to light
• Difficulty reading or recognizing faces
• Color blindness
• Requiring more time for eyes to adjust between light and dark spaces
• Vision loss that cannot be corrected with glasses

Difficulties are often most noticeable when trying to complete tasks that rely on sharp, detailed vision. The condition generally advances slowly, but the rate of progression varies from person to person.

How Stargardt Disease is Diagnosed

Stargardt disease is diagnosed through a combination of eye examinations, advanced imaging, and an understanding of the patient’s medical history. The process generally involves:

• A detailed dilated eye exam to observe the macula for the characteristic yellow lipofuscin spots
• Imaging tests, including Optical Coherence Tomography (OCT), Fluorescein Angiography (FA), and Electroretinography (ERG), all of which help to assess any functioning, abnormalities, or level of damage in the retina
• Genetic testing to confirm the condition by identifying mutations in the ABCA4 gene, or less commonly, the ELOVL4 and PROM1 genes.

Treatments and Management of Stargardt Disease

Currently, there is no cure for Stargardt disease. Treatment focuses on managing symptoms and maximizing remaining vision. As disease progression is unique to each patient, treatment is customized as well. Notes Holly, “Even two people who have macular degeneration don’t see the same way…each condition presents different obstacles. Being able to adapt care to each patient is really eye-opening.”

Managing Stargardt disease involves the following recommendations:

• Maintain good sun protection to prevent further retinal damage.
• Avoid smoking, as some studies have noted a correlation with dimming of vision.
• Monitor vitamin A intake, as excessive amounts may make the disease progress faster.
• Take advantage of low vision aids like magnifiers, specialized glasses, or other tools.

While there are no FDA-approved medications available at this time for the disease, treatment continues to advance. A new drug called gildeuretinol has recently shown promise in slowing or even stopping vision loss from Stargardt disease by reducing toxic buildup in the retina. While it’s still too early to know when the treatment might be widely available, the research has been granted special FDA designations to speed up development.

Finding Support

Perhaps the most important help in living with the challenges of Stargardt disease is having support. Friends, family, and even employers can make a difference by offering patience and understanding.

Equally important is having a supportive medical care team. At Midwest Low Vision, we’re proud to have Holly on our team—not only as a skilled technician but as someone who truly understands what patients are going through. Holly says of her experience, “It’s not a disability that you can see. And working specifically with low vision patients, it’s amazing to see the difference when I’m able to tell them, “Hey, I know what you’re going through. I struggle with this as well. It’s almost like you can see a sigh of relief because they’re so used to their friends and family, who have their best interest at heart but maybe just don’t know what they see or what they’re experiencing, and being able to relate to them—it really means a lot to them.”

Conclusion

Living with Stargardt disease presents challenges, but as Holly proves, it doesn’t have to mean giving up independence or quality of life. With the right management and support, patients can thrive. If you’ve been recently diagnosed, or are looking for additional care to manage your vision, please reach out to us today. We’re here to help.