Abstract
PurposeTo evaluate eye rubbing and sleeping position in patients with Unilateral or Highly Asymmetric Keratoconus (UHAKC).MethodsCase-control study of consecutive UHAKC patients diagnosed at the Rothschild Foundation. Controls were age- and sex-matched, randomly selected refractive surgery clinic patients. Patients self-administered questionnaires regarding their family history of keratoconus, eye rubbing, and sleeping habits. All the eyes underwent a comprehensive ocular examination. Logistic regression was used to analyze univariate and multivariate data to identify risk factors for keratoconus.ResultsThirty-three UHAKC patients and 64 controls were included. Univariate analyses showed that daytime eye rubbing [OR = 172.78], in the morning [OR = 24.3], or in eyes with the steepest keratometry [OR = 21.7] were significantly different between groups. Allergy [OR = 2.94], red eyes in the morning [OR = 6.36], and sleeping on stomach/sides [OR = 14.31] or on the same side as the steepest keratometry [OR = 94.72] were also significantly different. The multivariate model also showed statistical significance for most factors including daytime eye rubbing [OR = 134.96], in the morning [OR = 24.86], in the steepest eye [OR = 27.56], and sleeping on stomach/sides [OR = 65.02] or on the steepest side [OR = 144.02]. A univariate analysis in UHAKC group, comparing the worse and better eye, showed that eye rubbing [OR = 162.14] and sleeping position [OR = 99.74] were significantly (p < 0.001) associated with the worse eye.ConclusionOur data suggests that vigorous eye rubbing and incorrect sleeping position are associated with UHAKC. This is especially true in rubbing the most afflicted eye, and contributory sleep position, including positions placing pressure on the eye with the steepest keratometry.
Highlights
Keratoconus (KC) is a corneal ectatic disorder that has been classically defined as a progressive, asymmetric, and often bilateral, non-inflammatory condition occurring in adolescence or early adulthood that produces a thinning and steepening of the cornea and causes irregular astigmatism, myopia, and poor visual acuity [1]
Ninety-seven patients were included in this study: 33 cases (UHAKC) and 64 controls
Cases and controls were matched for age and sex
Summary
Keratoconus (KC) is a corneal ectatic disorder that has been classically defined as a progressive, asymmetric, and often bilateral, non-inflammatory condition occurring in adolescence or early adulthood that produces a thinning and steepening of the cornea and causes irregular astigmatism, myopia, and poor visual acuity [1]. The reported prevalence of eye rubbing ranges from 66 to 73% in patients with KC, which is concerning as approximately 15% of the worldwide population appears to be suffering from ocular allergies, even more so in industrialized countries [3]. Even if there is a genetic support [6], no causative gene(s) has yet been found and most of keratoconus cases are sporadic. This multifactorial disease with underlying genetic, biomechanical, and environmental processes has remained poorly understood for more than 150 years. Rabinowitz [8] and Naderan et al [9] performed case-control studies which found that keratoconus patients rubbed their eyes more often than normal controls (80 and 83% vs 58 and 52%, respectively)
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