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Klinik für Augenheilkunde

Wacker Lab: Cornea and Fuchs' Dystrophy

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, Amin SR, Baratz KH, Patel SV. Corneal High-Order Aberrations and Backscatter in Fuchs’ Endothelial Corneal Dystrophy Ophthalmology, 2015, Vol. 122(8):1645-52
  2. 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
  3. 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

  • 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.

  1. Wacker K, Baratz KH, Maguire LJ, McLaren JW, Patel SV. Descemet stripping endothelial keratoplasty for Fuchs’ endothelial corneal dystrophy: 5-year results of a prospective study Ophthalmology, 2016, Vol. 123(1):154–60
  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, DOI:10.1001/jamaophthalmol.2020.6994 
  3. 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
  4. 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, doi.org/10.1016/j.ophtha.2021.04.015

  • 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

  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.

  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

    Free Download of the V-FUCHS instrument (in US English) (in UK English) (in German)

Funding

  • Deutsche Forschungsgemeinschaft (DFG; German Research Foundation)
  • Dr. Werner Jackstädt Foundation
  • Deutsche Ophthalmologische Gesellschaft (DOG)
  • Berta Ottenstein Program for Advanced Clinician Scientists, University of Freiburg
  • Hermann A. and Maria O. Nuss Foundation, University of Freiburg
  • Program for Clinical Studies, University of Freiburg
  • Berta Ottenstein Program for Clinician Scientists, University of Freiburg
Principal Investigator

PD Dr. med. Katrin Wacker, FEBO
E-Mail

Background

  • MD, Albert-Ludwigs University of Freiburg 2006–2013
  • Thesis (Dr. med.), Reduction of corneal inflammation after keratoplasty in rat models. University of Freiburg, 2013
  • Postdoctoral Clinical Research Fellow, Mayo Clinic, Rochester, MN, USA, 2014–2015, 2016
  • Habilitation (Privatdozent),
    Functional and morphological changes in Fuchs' endothelial corneal dystrophy. University of Freiburg, 2020

Group

  • Stephanie Bixler, M.Sc.
    Augenoptik und Psychophysik
  • Franziska Brandi-Dohrn, MD student
  • Dr. Marianne Fritz
  • Dr. Andreas Glatz
  • Dr. Viviane Grewing
  • Dr. Judith-Lisa Lieberum
  • Dr. Anne-Marie Kladny
  • Claudia Müller, Augenoptikermeisterin
  • Daniel Zander, B.Sc., MD student

Publications