Predictors of vision-related quality of life in patients treated for filamentous fungal keratitis

Purpose

To identify clinical characteristics that predict vision-related quality of life (QoL) in patients with fungal keratitis three months after treatment.

Methods

Patients with fungal keratitis enrolled in the Cross-Linking Assisted Infection Reduction trial were treated with topical natamycin 5 % or amphotericin 0.15 %, with or without adjuvant corneal cross-linking (CXL). Demographic data, ulcer characteristics, clinical course, and responses to the Indian Visual Function Questionnaire (IND-VFQ) were collected at baseline and follow-up. Logistic regression models were used to assess factors associated with patient-reported vision-related QoL at three months. Analyses included the average IND-VFQ score as well as Rasch-derived subscale scores for vision-specific mobility, activity limitation, psychosocial impact, and visual symptoms.

Results

Of 111 participants enrolled, 86 had complete data at both timepoints. Multivariable models identified baseline IND-VFQ score, scar size, and presence of hypopyon as significant predictors of 3-month IND-VFQ scores. A 1-point change in best spectacle corrected visual acuity is correlated with a 13.4-point change in the opposite direction in average IND-VFQ (P=0.001). Patients with adverse events requiring surgery had lower 3-month IND-VFQ scores than those managed medically (P=0.001). Ulcer characteristics including location, depth, symptom duration, repeat culture positivity, organism type, and fungal genus were not associated with final IND-VFQ scores.

Conclusions

Vision-related QoL after fungal keratitis is significantly influenced by change in visual acuity, need for surgical intervention, and select baseline factors including scar size, initial IND-VFQ score, and presence of hypopyon. Vision-related QoL did not differ by antifungal treatment or adjuvant CXL use.