Abstract
Purpose :
Infectious keratitis is a vision-threatening condition requiring close follow-up and disciplined eye drop administration to achieve resolution. Although patients presenting to county hospitals often have a more severe presentation, there is a paucity of risk and outcomes data in this setting. This study investigates social risk factors predicting loss to follow-up, medication noncompliance, hospital admission, and poor outcomes for infectious keratitis in the county setting.
Methods :
We performed a retrospective case-control study at Zuckerberg San Francisco General Hospital and Trauma Center. Inclusion criteria were all patients who had corneal cultures for suspected infectious bacterial or fungal keratitis obtained between 2010-2021. Exclusion criteria were patients with viral keratitis only. Multivariable logistic regression was used to analyze the relationship of social and medical risk factors with loss to follow-up, medication noncompliance, hospital admission, worsened visual acuity, and delayed time to resolution.
Results :
Of 174 patients with infectious keratitis, 69 (40%) were lost to follow-up. Unemployment was associated with increased risk of loss to follow-up (OR 2.58, p=0.049). There was a trend toward an association with homelessness and noncompliance (OR 3.48, p=0.095). 47 patients (27%) were hospitalized for treatment of corneal ulcers. Hospitalization correlated with unemployment (p=0.033), homelessness (p=0.033), and drug use (p=0.006). Unemployment was significantly associated with worse final visual acuity (p=0.001). Increasing age correlated with longer healing time of the ulcer, with each one-year increase in age associated with delayed resolution by 0.549 days (p=0.042).
Conclusions :
Patients experiencing homelessness, unemployment, drug use, or increased age demonstrate higher risk for treatment barriers including loss to follow-up and medication noncompliance, resulting in worse visual acuity, risk for hospital admission, and delayed time to resolution. These risk factors should be considered when determining the need for hospitalization or more deliberate follow-up measures in patients with infectious keratitis.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.