Abstract
Purpose :
To determine risk factors for progression of keratoconus in a pediatric cohort
Methods :
Retrospective consecutive series of keratoconus pediatric patients seen by cornea specialists at the department of ophthalmology at Columbia University Medical Center from February 2015 to September 2020 were included. Mann Whitney U tests and Fisher exact tests were carried out to identify risk factors for progression of keratoconus. Subgroup analysis of older (>14 years of age) pediatric patients was carried out. Advanced keratoconus was defined as a pachymeter measurement of <400um in at least one eye.
Results :
Of the 33 included pediatric patients, 7 met the definition of advanced keratoconus. Of the advanced keratoconus patients, age, sex, and reported seasonal allergies were not statistically significant. 4 out of 10 patients of the age <14 cohort presented with advanced keratoconus, compared with 3 out of 20 patients in the age >14 group (p = 0.161). The median income of the zip codes of these patients showed a trend (although did not reach statistical significance) of lower incomes in the advanced keratoconus group ($52,200 vs $76,200) (p = 0.074). 21 patients showed progression by their second visit. No statistically significant differences were found between the group (in terms of age, sex, and presence of reported allergies) that showed progression and the group that did not. The Kmax value for those that progressed by the second visit was statistically significantly higher (61.8) than the patients who did not progress by the second visit (55.0, p = 0.042).
Conclusions :
Cross linking treatment for keratoconus is currently approved for age >14 years but not for the very young pediatric population. In our study,here was a non-statistically significant trend for patients of age <14 and for patients from lower income zip codes to present more frequently with advanced keratoconus. The majority of patients progressed by their second visit. Kmax values were shown to be statistically significantly different in the group that showed progression by the second visit Although our retrospective data collection had a limited number of patients, our data suggests that risk factors for presenting with advanced keratoconus may include coming from an area of lower median income, which may be an important factor to note as a social determinant of health.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.