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Observational Study
. 2025 Jun 19;51(8):336-342.
doi: 10.1097/ICL.0000000000001200.

Symptoms as an Indicator of Microbial Keratitis Severity and Its Association With Visual Acuity

Dena Ballouz  1 , Leslie M Niziol, N Venkatesh Prajna, Sina Farsiu, Roni M Shtein, Angela Verkade, Keith D Miller, Eric Sherman, Mercy Pawar, Suvitha Selvaraj, Dhanya Kuppuraj, Prabhleen Kochar, Alexa Thibodeau, Jennifer Enright, Maria A Woodward
Affiliations
Observational Study

Symptoms as an Indicator of Microbial Keratitis Severity and Its Association With Visual Acuity

Dena Ballouz et al. Eye Contact Lens. .

Abstract

Objective: Microbial keratitis (MK) is a vision-threatening and often painful corneal infection. This study aims to quantify severity of symptoms of MK at presentation and investigate their association with visual acuity (VA).

Methods: The Automated Quantitative Ulcer Analysis (AQUA) study recruited MK patients from two sites (University of Michigan and Aravind Eye Care System). At presentation, best-corrected VA was recorded. Patients were surveyed on severity of symptoms on a five-point scale for pain or a four-point scale for redness, light sensitivity/glare, and blurry vision. The association between symptom severity and VA was tested with Spearman correlations (r) and Kruskal-Wallis tests.

Results: Seven hundred three patients with MK were enrolled in the AQUA study from July 2020 to November 2022. Presenting logMAR VA had a median value of 1.3 (Snellen equivalent, 20/400). Most patients reported pain (98.7%), redness (99.1%), light sensitivity/glare (98.4%), and blurry vision (99.2%). Visual acuity showed a significant correlation with cumulative symptom severity (spearman r=0.15, P <0.0001). For those who reported pain and blurry vision, VA worsened with increasing symptom severity ( P <0.0001).

Conclusions: Presenting VA showed a significant positive correlation with cumulative symptom severity and the individual symptoms of pain and blurry vision. Patient-reported symptoms at MK presentation may indicate disease severity.

Keywords: Microbial keratitis; Visual acuity; symptoms.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose. Funding for this research was provided by the National Eye Institute (R01EY031033, M.A. Woodward), (P30 EY005722, S. Farsiu), and a Research to Prevent Blindness Career Advancement Award (M.A. Woodward). For the remaining authors no disclosures were declared. The funding support played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. None of the following authors have any proprietary interests or conflicts of interest related to this submission.

Figures

Figure 1.
Figure 1.
Stacked bar chart displaying the percentage of AQUA study participants with microbial keratitis who self-reported each level of symptom severity, overall and stratified by study site. AQUA, Automated Quantitative Ulcer Analysis; UM, University of Michigan; AECS, Aravind Eye Care System.
See this image and copyright information in PMC

References

    1. Musch DC, Sugar A, Meyer RF. Demographic and predisposing factors in corneal ulceration. Arch Ophthalmol (Chicago, Ill 1960). 1983;101(10):1545–1548. doi: 10.1001/archopht.1983.01040020547007 - DOI - PubMed
    1. Collier SA, Gronostaj MP, MacGurn AK, et al. Estimated burden of keratitis--United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(45):1027–1030. - PMC - PubMed
    1. Ting DSJ, Ho CS, Deshmukh R, Said DG, Dua HS. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond). 2021;35(4):1084–1101. doi: 10.1038/s41433-020-01339-3 - DOI - PMC - PubMed
    1. Ung L, Bispo PJM, Shanbhag SS, Gilmore MS, Chodosh J. The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol. 2019;64(3):255–271. doi: 10.1016/j.survophthal.2018.12.003 - DOI - PMC - PubMed
    1. Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: a prospective clinical and microbiological study. Br J Ophthalmol. 2001;85(7):842 LP - 847. doi: 10.1136/bjo.85.7.842 - DOI - PMC - PubMed

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