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Jennifer J Ling, Shahzad Mian, Joshua D Stein, Moshiur Rahman, Maria A Woodward; Impact of scleral contact lens use on risk of requiring corneal transplantation for keratoconus. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4779.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the association between scleral contact lens (SCL) use and the need for subsequent deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PKP) for patients with corneal ectasia from keratoconus (KCN).
The Sight Outcomes Research (SOURCE) Repository was used to capture electronic health record (EHR) data for patients receiving eye care at participating academic centers between 2012 and 2018. All patients with two encounters with International Classification of Diseases (ICD) diagnosis codes of KCN or corneal ectasia and no prior history of keratoplasty were identified. Potential risk factors for receiving a corneal transplant including sociodemographic factors (age, gender, ethnicity, insurance status, and community of residence) and use of SCL or rigid gas permeable (RGP) contact lenses were extracted from the EHR. A multivariable Cox regression (survival analysis) was performed to test associations between these various risk factors and the receipt of keratoplasty.
A total of 1,683 patients with KCN met the inclusion criteria. Among these, 246 patients (14.6%) used SCLs. There were 103 patients with KCN (6.1%) who underwent keratoplasty. The proportion of patients using and not using SCLs who underwent keratoplasty was 2.03% and 6.82%, respectively (p=0.004).In the multivariable model, use of a SCL was associated with 72.7% decreased hazard of a patient requiring keratoplasty (HR=0.27, 95% CI 0.11-0.67, p<0.005). Factors associated with an increased hazard of keratoplasty were black race (versus white) (HR=1.68, 95% CI 1.06-2.65, p=0.03), younger age (HR=1.02, 95% CI 1.06-1.03, p=0.007), and lower socioeconomic status of a participant’s residential neighborhood (HR=1.02, 95% CI 1.01-1.02, p=0.0002). RGP use, gender, and insurance status were not associated with receiving keratoplasty.
Patients who use SCLs for KCN had a significantly lower risk of requiring keratoplasty. If these findings are substantiated, wide scale use of SCLs in KCN may be warranted. Certain demographic factors also independently increased the likelihood of keratoplasty.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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