postdsaek optical changes a comprehensive prospective analysis on the role of ocular wavefront aberrations haze and corneal thickness purpose the aim was to assess the visual impact of ocular wavefront aberrations corneal thickness and corneal light scatter prospectively after performing a descemet stripping automated endothelial keratoplasty dsaek in humansmethods data were obtained prospectively from 20 eyes preoperatively and at 1 3 6 and 12 months postdsaek at each visit the best spectaclecorrected visual acuity and visual acuity with glare brightness acuity testing were recorded and ocular wavefront measurements and corneal optical coherence tomography oct were performed the magnitude and the sign of individual zernike terms higherorder aberrations hoas were determined epithelial host stromal donor stromal and total corneal thicknesses were quantified the brightness and intensity profiles of oct images were generated to quantify light scatter in the whole cornea subepithelial region anterior and posterior host stroma interface and donor stromaresults the mean best spectaclecorrected visual acuity and glare disability at low light levels improved from 1 to 12 months postdsaek all corneal thicknesses and ocular lowerorder aberrations and hoas were found to be stable from 1 to 12 months whereas total corneal host stromal and interface brightness intensities decreased significantly over the same period a repeated measures analysis of variance performed across the followup period revealed that the change in scatter but not the change in the hoas could account for the variability occurring in the acuity from 1 to 12 months postdsaekconclusions although ocular hoas and scatter are both elevated over normal values postdsaek our results demonstrate that the improvements in visual performance occurring over the first year postdsaek are associated with decreasing light scatter in contrast there were no significant changes in the ocular hoas during this time because corneal light scatter decreased between 1 and 12 months despite there being stable corneal thicknesses over the same period we conclude that factors that induced light scatter other than tissue thickness or swelling corneal edema significantly impacted the visual improvements that occurred over time postdsaek a better understanding of the cellular and extracellular matrix changes of the subepithelial region and interface incurred by the surgical creation of a lamellar hostgraft interface and the subsequent healing of these tissues is warranted