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Gwinyai Chikwava, Li Wang, Chasidy Singleton; Prevalence and Severity of Keratoconus in an Underserved Population in Nashville, Tennessee. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6198.
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© ARVO (1962-2015); The Authors (2016-present)
Keratoconus (KCN), the most common corneal degeneration, can cause significant visual impairment due to astigmatism and corneal scarring, but can be treated non-surgically if detected at early stages. Patients with poor access to care may present at an older age, with blindness and require surgery.
To estimate the prevalence of KCN and presentation of legal blindness in an urban, underserved population, a retrospective IRB-approved chart review of new patient encounters (from 2006-2011) at Nashville General County Eye Clinic was performed. Data were analyzed by descriptive statistics. Of a total 4700 new patients, 34 had KCN (identified by ICD-9 codes 371.6x). Patients were stratified by age, gender, race, best-corrected vision, and need for surgical treatment. Any associated socioeconomic, medical, or environmental factors were identified.
The prevalence of KCN over 5 years in this underserved population was 0.7%, which was statistically significant (p<0.001) compared to the documented U.S. prevalence of 0.054%. Average age at presentation was 33.32 ± 11.94 (range 25 to 41 years). By race, 5.9% identified as Caucasian, 76.5% as African-American, 14.7% Hispanic, and 2.9% of other ethnicities. Females comprised 26.5% and males 73.5%. 44.1% of patients were incarcerated and 26.4% were uninsured. Prior ocular/head trauma was endorsed by 42.9%. Legal blindness was seen in 32.4% of right eyes, and 38.2% of left eyes. Most of the patients had no associated medical co-morbidities. Seasonal allergies were present in 5.9%. All patients received treatment, with 35.3% requiring corneal transplantation surgery.
Patients in this underserved population exhibit a higher prevalence of KCN than the general US population and required surgical treatment at initial presentation. Nationally, surgery is required in less than 20% of all patients with KCN. Patients with advanced disease tended to be older, uninsured or incarcerated, and endorse a history of prior ocular trauma. Few reported seasonal allergies.
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