Abstract
Purpose :
Over 150,000 people in the United States are afflicted with keratoconus (KCN)—a corneal ectatic disease characterized by progressive corneal thinning. Until the recent advent of corneal crosslinking (CXL), one of the only treatment options for advanced KCN was corneal transplantation. Early diagnosis of KCN and subsequent CXL treatment has been shown to improve outcomes in patients suffering from KCN. At Wake Forest Baptist Health (WFBH), we have noticed a trend in referral patterns in which black patients often present to our department with more advanced KCN than non-black patients, which may lead to a delay in treatment and poorer outcomes.
Methods :
We performed a retrospective review of patients presenting to WFBH between 2018-2020 for KCN evaluation. For each patient, demographic and referral information was collected. Exclusion criterion included prior corneal surgery or CXL. Outcome measures were best corrected visual acuity (BCVA), presence of corneal scarring, keratometry values, ABCD score, and recommended treatment plan. Follow-through with the recommended treatment plan was evaluated between groups within 6-months of initial consultation. Chi squared tests were used to perform statistical analyses.
Results :
128 patients were included the study. According to demographic information collected, black patients presented with a higher BMI and a more evenly distributed (1:1) male-to-female ratio. Tomographic outcomes showed that black patients presented with worse BCVA (p < 0.0001), worse tomographic keratoconus staging (p < 0.0001), and were more likely to have corneal thinning (p < 0.0001) or scarring (p < 0.0001) precluding corneal cross-linking when compared to non-black patients. There was no significant difference in the likelihood that black patients would follow through with a proposed treatment plan. However, there were poor follow-up rates among both groups—thus limiting the strength of this conclusion.
Conclusions :
When compared to their non-black counterparts, black patients presented to our institution with more advanced KCN which often precluded CXL as a viable treatment option. Black patients were also just as likely to follow through with a proposed treatment plan.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.