Abstract
Purpose :
Few studies have investigated the relationship between socioeconomic factors and keratoconus disease burden. We performed a retrospective cohort study to explore the relationship between socioeconomic, demographic, and concurrent medical conditions with keratoconus disease burden among different patient populations at a single institution.
Methods :
In this study, 21,157 Scheimpflug topography images from 2014 to 2021 were screened for keratoconus. Inclusion criteria included steep keratometry ≥47 diopters and a Belin-Ambrósio enhanced ectasia display total deviation value (BAD D) ≥1.6. The electronic medical record was reviewed for patient demographics, socioeconomic factors, and medical comorbidities. Outcomes included moderate keratoconus at presentation (steep keratometry ≥47 diopters), progression of disease (≥1 diopters increase from baseline), and loss to follow-up within two years. Univariate and multivariate logistic regression analysis was performed to explore the relationship between predictor variables and the aforementioned outcomes.
Results :
A total of 798 patients met inclusion criteria. Patients younger than 50 years old were more likely to present with severe disease (OR 1.60; 95% CI, 1.16-2.19, p=0.020). Those with connective tissue disorders (OR 4.56, 95% CI, 2.18-10.34, p=0.002) had a higher likelihood of severe presentation whereas patients with sleep apnea were less likely to present with severe disease (OR 0.23; 95% CI, 0.03-0.91, p<0.001). Uninsured patients were more likely to be lost to follow-up, independent of social or clinical confounders (OR 1.70; 95% CI, 1.02-2.93, p=0.017). Males were more likely to progress to more severe disease (OR 1.64; 95% CI, 1.01-2.67, p=0.022, N=313) along with smokers and diabetics (OR 3.23; 95% CI, 1.05-14.13, p=0.001, N=313 and OR 2.65; 95% CI, 1.06-7.50, p<0.001, N=313, respectively). Family history, atopic disease, thyroid disease, and dry eye were not significantly associated with severity or progression of disease.
Conclusions :
Our study revealed certain socioeconomic factors and systemic medical conditions increased odds of severity of keratoconus disease at presentation, of disease progression, and of lost to follow-up rates. These findings underscore the importance of targeted interventions to mitigate disparities in access to care and highlight specific demographics influencing disease burden and patient follow-up in keratoconus management.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.