Abstract
Purpose :
To describe sociodemographic patterns for corneal collagen crosslinking(CXL) and keratoplasty(KER) following diagnosis of keratoconus (KCN) in the IRIS® Registry (Intelligent Research in Sight) in light of FDA approval of CXL in 2016.
Methods :
Using the American Academy of Ophthalmology IRIS® Registry, patients with a diagnosis of KCN on ≥ 2 consecutive visits between 01/01/2015 and 12/31/2020 were identified by ICD-10 codes. Patients without topography or pachymetry (CPT code) performed within 30 days after KCN diagnosis were excluded to focus on newly diagnosed KCN. Patients with CXL and KER procedures (CPT codes) following KCN diagnosis were then identified. Sociodemographic factors, e.g. age, sex, race, insurance status, were characterized and compared between KCN patients with and without CXL and KER.
Results :
Of the 78,976 patients who met the inclusion criteria for newly diagnosed KCN, 11% (8,854) underwent CXL, 5% (3,859) had KER and 84% (66,460) had neither procedure (NP). CXL patients tended to be younger than patients with KER or NP [mean age (SD): CXL: 29.8(11.0) yrs. vs KER: 41.1(14.9) yrs. vs NP: 43.6(17.5) yrs] (p<0.0001). CXL patients had a higher proportion of males (69%) vs KER patients (60%) and NP patients (56%), a higher proportion of Whites (51%) vs 45% (KER) and 51% (NP), and lower percentage of Blacks [11% (CXL) vs 29% (KER) and 15% (NP)] (all p values <0.001). CXL, KER and NP frequencies varied by geographic region, the highest frequency was in the South and lowest in the Northeast for the three groups. Insurance status varied across the three groups(P<0.0001). KER patients, vs. those with CXL and NP, had a lower frequency of private insurance (83% vs 91% and 89%, respectively) and higher frequency of Medicaid or no insurance (17% vs 11% and 10%). Time between initial KCN diagnosis and procedure was shorter for CXL vs KER [mean (SD) 261 (325) days vs 339 (395) days] overall and for each age category(p<0.0001). The number of CXL cases more than doubled between 2016 and 2019 from 1097 to 2259 while KER cases decreased by more than half from 1109 to 471 cases during that same period.
Conclusions :
Although CXL has revolutionized the treatment approach for KCN, there may be sociodemographic differences in access and/or utilization. Further studies are needed to identify the reasons for these differences to optimize access for all patients.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.