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Risk factors and association with severity of keratoconus: the Australian study of Keratoconus

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Abstract

Significance

Our results show that asthmatic patients tend to have more severe KC and thus close monitoring for disease progression would be advised, and appropriate treatment strategies may be actioned stabilise the condition that may reduce the need for future corneal transplantation.

Purpose

To explore a wide range of risk factors associated with the severity of keratoconus (KC).

Methods

A cross-sectional study of KC patients was undertaken in Melbourne, Australia. A questionnaire addressing age, gender, educational background, ocular and medical history, smoking and alcohol consumption, and physical examination comprising anthropometric measurements was collected; eye examination was undertaken. The associations between a range of risk factors and the severity of KC were determined using univariate and multivariable linear regression analyses.

Results

A total of 260 KC subjects were included in this study. Mean age of subject was 35.5 (SD = 14.8) years and the majority of the subjects were European 171 (68.2%). Initial univariate regression analysis identified the following risk factors at the p < 0.1 level with KC: higher body mass index, smoking cigarettes, diabetes, rheumatoid arthritis and asthma were associated with increased severity of KC, whereas eczema was associated with less severe KC. Following multivariable regression analysis, only asthma remained as a significant risk factor associated with 2.2 diopters (D) steeper average mean keratometry compared to KC subjects having no asthma [p = 0.03; β = 2.18; 95% confidence intervals: 1.22, 4.14].

Conclusion

Our study describes the comprehensive assessment of all the known risk factors in a large KC cohort recruited in Australia. Our study has reported asthma as the only risk factor found to be significantly associated with the severity of KC. The results of this study allow us to better understand the aetiology of KC and such knowledge could be useful in instigate systemic management of patients to slow or prevent KC.

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Acknowledgements

The authors wish to thank participants from the Keratoconus study who made this work possible. The authors would also like to thank the Eye surgery associates, Lindsay and associates and Keratoconus Australia, Mr Tony Ngo for their assistance with recruitment. A preliminary report on some of these data was presented at the Asia cornea society meeting, Taipei, Taiwan, Dec, 2014.

Funding

This study was supported by the Australian National Health and Medical Research Council (NHMRC) project ideas grant APP1187763 and senior research fellowship (1138585 to PNB), Lions Eye Donation Service (SS), Angior Family Foundation (SS) and Perpetual Impact Philanthropy grant (SS). The Centre for Eye Research Australia (CERA) receives operational infrastructure support from the Victorian government. The sponsor or funding organizations had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Centre for Eye Research Australia, Melbourne, VIC, Australia

    Srujana Sahebjada, Elsie Chan, Jing Xie, Grant R. Snibson & Mark Daniell

  2. The University of Melbourne, Melbourne, VIC, Australia

    Srujana Sahebjada, Elsie Chan, Grant R. Snibson, Mark Daniell & Paul N. Baird

  3. Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia

    Elsie Chan, Grant R. Snibson & Mark Daniell

  4. Monash University Melbourne, Melbourne, VIC, Australia

    Jing Xie

Authors
  1. Srujana Sahebjada
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  2. Elsie Chan
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Correspondence to Srujana Sahebjada.

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The author declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Royal victorian eye and ear hospital human research and ethics committee (Project # 10/954H) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sahebjada, S., Chan, E., Xie, J. et al. Risk factors and association with severity of keratoconus: the Australian study of Keratoconus. Int Ophthalmol 41, 891–899 (2021). https://doi.org/10.1007/s10792-020-01644-6

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  • DOI: https://doi.org/10.1007/s10792-020-01644-6

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