The Relation of Ocular Surface Irregularity and Visual Disturbance in Early Stage Acanthamoeba Keratitis

Purpose: To evaluate the relation between ocular surface irregularity and visual disturbance in early stage Acanthamoeba keratitis (AK). Methods: Fifteen patients with culture-proven AK underwent routine ophthalmic examinations, including best-corrected visual acuity (BCVA) measurement, slitlamp biomicroscope examination, and corneal fluorescein dye staining test, in both the eyes. We also evaluated the corneal sensitivity with Cochet-Bonnet esthesiometer, tear functions by Schirmer's test, and ocular surface irregularity by corneal topography and compared the results with the contralateral healthy eyes in this study. Results: The mean logarithm of the minimum angle of resolution BCVA (0.71 +/- 0.77) was significantly lower in the eyes with AK (P = 0.002). Epithelial disorders were present in all eyes, and radial keratoneuritis in 14 eyes (93.3%). The mean corneal sensitivity (39.3 +/- 24.1 mm) was significantly lower in eyes with AK compared with the healthy eyes (P = 0.005). The mean Schirmer's test value (22.5 +/- 12.0 mm) in eyes with AK was significantly higher compared with the healthy eyes (P = 0.01). The ocular surface irregularity indices (the surface regularity index, 2.47 +/- 0.42; the surface asymmetry index, 3.24 +/- 1.31) were significantly higher in eyes with AK compared with contralateral healthy eyes (P<0.0001 and P<0.0001, respectively). Conclusions: The ocular surface disease in AK is associated with decrease in corneal sensitivity and increase in Schirmer's test value and ocular surface irregularity indices. The visual disturbance in AK may owe not only to corneal haze but also to ocular surface irregularity.