Klinik für Augenheilkunde

Our research focuses on the anterior surface of the eye, the cornea. We integrate methods from observational studies, randomized-controlled trials, and basic science to discover and validate determinants of corneal diseases.

Objectives

We aim to contribute to a better understanding of corneal diseases in order to improve patient outcomes. We have a special interest in Fuchs’ endothelial corneal dystrophy, the most common indication for corneal transplantation. Our work attempts to connect clinical disease staging with the underlying molecular and pathophysiologic changes.

• Corneal pathophysiology and optics
  Molecular and morphological changes of the cornea impair patients’ quality of vision. We develop standardized techniques to comprehensively evaluate disease severity. These tools are designed for research purposes and for a standardized clinical evaluation that supports evidence-based treatment selection. Selected references:

1. Wacker K, McLaren JW, Kane KM, Baratz KH, Patel SV. Corneal hydration control in Fuchs endothelial corneal dystrophy (open access)
   Invest Ophthalmol Vis Sci, 2016, Vol. 57(11):5060–65
2. Fritz M, Grewing V, Lapp T, Maier P, Böhringer D, Reinhard T, Wacker K. Diurnal Variation in Corneal Edema in Fuchs Endothelial Corneal Dystrophy Am J Ophthalmology, 2019, Vol. 207:351-355
3. De Jong B, Brandi-Dohrn F, van der Meulen I, van den Berg T, Wacker K. Diurnal Variation in Straylight in Patients With Fuchs Endothelial Corneal Dystrophy and Controls Cornea, 2022, doi: 10.1097/ICO.0000000000003002

• Medical and surgical treatments for Fuchs’ dystrophy
  Corneal remodeling starts early in the course of Fuchs’ dystrophy resulting in visual disability. In prospective observational studies and randomized-controlled trials, we assess how clinical, morphological, and molecular measures can be used to evaluate and predict patient-relevant outcomes of minimally invasive techniques for corneal endothelial transplantation (DMEK) and of non-surgical approaches to Fuchs’ dystrophy. Selected references:

1. Fritz M*, Grewing V*, Gruber M, Wagner H, Zander D, Lapp T, Lang SJ, Heinzelmann-Mink S, Maier P, Reinhard T, Wacker K. Rotational alignment of corneal endothelial grafts and risk of graft detachment after Descemet membrane endothelial keratoplasty: a double-masked pseudo-randomized study (open access) Acta Ophthalmologica, 2021, doi.org/10.1111/aos.14849
2. Zander D, Böhringer B, Fritz M, Grewing V, Maier PC, Lapp T, Reinhard T, WackerK. Hyperosmolar eye drops for diurnal corneal edema in Fuchs’ endothelial dystrophy: a double-blind randomized-controlled trial (open access) Ophthalmology, 2021, 128(11):1527-1533
3. Kladny AMK, Zander DB, Lieberum JL, Glatz A, Brandi-Dohrn F, Reinhard T, Wacker K. Graft Detachment after Descemet Membrane Endothelial Keratoplasty with and without Cataract Surgery (open access) Ophthalmology Science, 2022, 2(4):100194

• Refractive outcomes of cataract surgery
  Most surgeons recognize and plan for the hyperopic shift that occurs when performing simultaneous cataract surgery and endothelial keratoplasty in patients with Fuchs’ dystrophy. We have shown how intraocular lens choices should consider the posterior profile of the cornea to avoid hyperopic surprises. Selected references:

1. Wacker K, McLaren JW, Patel SV. Directional posterior profile changes in Fuchs endothelial corneal dystrophy (open access)
   Invest Ophthalmol Vis Sci, 2015, Vol. 56(10):5904–11
2. Wacker K, Cavalcante LCB, Baratz KH, Patel SV. Hyperopic Trend after Cataract Surgery in Eyes with Fuchs' Endothelial Corneal Dystrophy. Ophthalmology, 2018, Vol. 125:1302-1304
3. Fritz M, Grewing V, Böhringer D, Lapp T, Maier P, Reinhard T, Wacker K. Avoiding hyperopic surprises after Descemet membrane endothelial keratoplasty in Fuchs dystrophy eyes by assessing corneal shape Am J Ophthalmology, 2019, Vol. 197:1-6

• V-FUCHS, a validated Fuchs dystrophy-specific patient-reported outcome measure
  The Visual Function and Corneal Health Status (V-FUCHS) instrument is designed to quantify patient-centered outcome measures in order to guide individualized treatment decisions in Fuchs dystrophy. V-FUCHS is available in English and German. Clinicians and investigators are welcome to apply the validated English and German versions of V-FUCHS. Please contact us with any questions or when planning to deploy V-FUCHS in other languages. Selected references: 

1. Wacker K, Baratz KH, Bourne WM, Patel SV. Patient-Reported Visual Disability in Fuchs’ Endothelial Corneal Dystrophy Measured by the Visual Function and Corneal Health Status (V-FUCHS) Instrument Ophthalmology, 2018, Vol. 125(12):1854-1861
2. Grewing V, Fritz M, Müller C, Böhringer D, Reinhard T, Patel SV, Wacker K. [The German version of the Visual Function and Corneal Health Status (V‑FUCHS): a Fuchs dystrophy-specific visual disability instrument] Ophthalmologe, 2020, Vol. 117(2):140-146
3. Wacker K, Grewing V, Fritz M, Böhringer D, Reinhard T. Morphological and optical determinants of visual disability in Fuchs’ endothelial corneal dystrophy Cornea, 2020, 39(6):726-731
   
   Download of the V-FUCHS instrument: (in US English) (in UK English) (in German)

• Automated image analysis

1. Wacker K, McLaren JW, Patel SV. Directional Posterior Corneal Profile Changes in Fuchs' Endothelial Corneal Dystrophy (open access) Invest Ophthalmol Vis Sci, 2015, 56:5904-5911
2. Zander D, Grewing V, Glatz A, Lapp T, Maier P, Reinhard T, Wacker K. Predicting edema resolution after Descemet membrane endothelial keratoplasty for Fuchs dystrophy using Scheimpflug tomography JAMA Ophthalmol, 2021, 139(4):423-430 
3. Glatz A, Böhringer D, Zander D, Grewing V, Fritz M, Müller C, Bixler S, Reinhard T, Wacker K.  Three-Dimensional Map of Descemet Membrane Endothelial Keratoplasty Detachment: Development and Application of a Deep Learning Model (open access) Ophthalmology Science, 2021, 1(4):100067

Interested in cornea?

Students are welcome to join our seminar on anterior segment pathology, corneal optics, and genetics (course catalogue, #04LE59S-Auge0010FA).