Abstract
Purpose :
The treatment of keratoconus has evolved over the past decades to include advanced contact lenses, intrastromal implants, and corneal crosslinking in addition to keratoplasty— all of which are most appropriate at different stages of disease. We performed a retrospective review to elucidate current trends and identify potential disparities in keratoconus treatment.
Methods :
We extracted data from electronic medical records of 1,135 patients with keratoconus seen at the Wilmer Eye Institute from January 2017 to September 2020. We used t-tests and chi square tests to detect associations between patient characteristics and various treatment modalities, including corneal crosslinking and keratoplasty. Logistic regression models adjusted for age, sex, race, insurance, and family history of allergies were constructed to calculate odds ratios (OR) describing these associations.
Results :
A total of 1,135 patients with a mean age of 40.5 (SD 16.5), were included, about half of whom were white (51.5%). In unadjusted analysis, patients who were younger (25.0 vs. 42.3 years), male (73.9% vs. 26.1% for females), white (52.3% vs. 25.2% for black patients) and who had private insurance (94.6% vs. 5.4% for government insurance) were significantly (p<0.05 for all) more likely to have had corneal crosslinking. No factor was associated with keratoplasty during this period. In a multivariable logistic regression model, black patients had lower odds of receiving corneal crosslinking compared to white patients (OR 0.58 95% CI 0.34-0.98). Increasing age was also associated with lower odds of corneal crosslinking (OR 0.91 95% CI 0.89-0.93).
Conclusions :
This study identifies racial disparities in keratoconus management with corneal crosslinking. These results are of interest as most health care payors have only recently started to endorse CXL as a covered benefit. Further analyses are needed to determine whether these disparities are related to socioeconomic barriers, disease severity, insurance coverage or other factors.
This is a 2021 ARVO Annual Meeting abstract.