Pediatric Keratoconus Research Articles

Incidence and presenting clinical features of pediatric keratoconus in a US population

PurposeTo report both the incidence of pediatric keratoconus (PKC) in a population-based cohort and the risk for undergoing corneal surgery over a 20-year period at a single institution. MethodsThe medical records of all patients <19 years of age diagnosed with keratoconus while residing in Olmsted County, Minnesota, from January 1, 1975, through December 31, 2019, were retrospectively reviewed. The records of patients <19 years with keratoconus examined at our institution from January 1, 2001, through December 31, 2020, were also reviewed. ResultsThe incidence of PKC in this population over the 45-year study period was 2.48 cases per 100,000 people per year (95% CI, 1.67-3.29). The mean age at diagnosis was 15.25 years (range, 7-18) years, and 28 (77.8%) were male. During a mean follow-up of 2.8 years (range, 0-17.3 years), 33 of 71 patients managed at our institution (46%) underwent at least one corneal procedure. In this cohort, the Kaplan-Meier risk of requiring a procedure by 10 years following diagnosis was 60%. ConclusionsThe incidence of PKC in Olmsted County, Minnesota, over a 45-year period was 2.48 cases per 100,000 people per year. Nearly half of the patients managed at our institution over the past 20 years required a procedure during follow-up.

Pediatric keratoconus in a tertiary eye hospital in Eastern province, Saudi Arabia: Patient characteristics and management outcomes.

This study investigates pediatric keratoconus in a tertiary eye hospital in Eastern Province, Saudi Arabia, aiming to understand the presenting features and treatment outcomes in this high-prevalence region. The research addresses pediatric keratoconus clinical profile and management strategies. A retrospective cohort study was conducted from 2022 to 2023, reviewing medical records of pediatric keratoconus patients. Demographic data, clinical characteristics, risk factors, presenting symptoms, and treatment outcomes were recorded. Severity staging was performed based on Amsler-Krumeich's classification. The study included 218 eyes from 109 pediatric keratoconus patients, with 65% of male and 35% of female patients. Decreased vision was the most common symptom (92%), and risk factors included a family history of keratoconus (9%) and vernal keratoconjunctivitis (6%). Stage 1 was the most frequent in both age groups (<14 years and ≥ 14 years). Treatment strategies included corneal collagen cross-linking (CXL), hard contact lenses, corneal rings, deep anterior lamellar keratoplasty (DLK), and penetrating keratoplasty. Significant improvements were observed in visual acuity, refractive errors, and tomographic parameters following these interventions. This study provides valuable insights into pediatric keratoconus in Saudi Arabia, emphasizing the importance of early diagnosis and interventions for better outcomes. Larger, multicenter prospective studies are essential for a comprehensive understanding of pediatric keratoconus and its optimal management. The findings contribute to the knowledge base and guide future research to improve patient quality of life.

Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and mean platelet volume levels in pediatric keratoconus patients.

To examine the level of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in the pediatric patient group with keratoconus. Patients aged 5-18 years with a diagnosis of keratoconus followed by the corneal department and children in the similar age group who were determined as controls were included in the study. Their topographies were evaluated. In both groups, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and mean platelet volume (MPV) were measured. The study group consisted of children aged 15 ± 1.4 years and the control group 13 ± 1.3 years of age. The mean central corneal thickness of the patients in the patient group was 445.64 μm, and in the control group was 532.25 μm. The NLR was 3.37 ± 1.04 in the patient group and 2.31 ± 0.82 in the control group. The PLR was significantly increased in the KC group (147.54 ± 41.36) than in the control group (118.71 ± 27.11) (P = 0.042). MPV in the patient group was 12.18 ± 2.76 and 7.00 ± 1.37 in the control group. This value was found to be statistically significant (P = 0.047) when the control group and the patient group were compared. Platelet/lymphocyte ratio and mean platelet volume, which are thought to be new markers of systemic inflammation, may be new indices in keratoconus in pediatric patients.

Keratoconus presentation with respect to age, gender, and severity in Western India

Purpose: To study the demographic profile of keratoconus (KC) patients visiting a tertiary eye care hospital in Western India. Materials and Methods: This cross-sectional, observational study included newly diagnosed KC patients visiting our hospital between January 2018 and October 2022. Patient’s demographic details (self-reported age at first presentation, age at diagnosis, and sex) and mean maximum curvature (K Max) were collected. The patients were divided into age band of 5-year groups. A subanalysis of gender and severity was performed among groups. Spearman’s correlation coefficient was used to evaluate the relationship between KC severity and age. Results: A total of 536 patients with clinical KC were included. A self-reported age at first presentation was 19.4 ± 6.2 years. The mean age of diagnosis was 20.5 ± 6.0 years (range: 4–43 years). There were 61.6% (330) of males and 38.4% (206) of females (P &lt; 0.01). The mean K Max value was 59.2 ± 13.3 diopter (D). The mean K Max was not significantly different between the sexes, with the exception of the age range of 24–28 years, where females had more severe KC than males (P = 0.02). Among the included patients, 38.6% (207) of patients were pediatrics (≤18 years), while 61.4% (329) were adults (&gt;18 years). The mean K Max in pediatric KC (62.3 ± 15.1 D) was significantly higher than adult KC (57.3 ± 11.5), P &lt; 0.01. Severity of KC did not correlate with the age of the patients (r = −0.20, P = 0.04). Conclusion: KC presented at a younger age with moderate-to-severe stage of the disease, indicating the need for early KC detection in our population.

Corneal Collagen Cross-Linking (CXL) in Pediatric Keratoconus: Changes in Visual Acuity and Biomechanical Properties

Abstract&#x0D; Introduction &amp; Objectives : Keratoconus is a progressive disease that changes the mechanical shape of the cornea due to thinning of the stromal layer of the cornea. Therefore, early detection and correct management should be able to slow the progression of the disease. This study aimed to compare changes in visual acuity and biomechanic properties of cornea in patients who underwent Corneal Collagen Cross- Linking (CXL) in Dr. Sardjito General Hospital&#x0D; Methods : This is a prospective study that included all pediatric keratoconus patients without any underlying disease that underwent CXL between July 2022 to December 2022. Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), Central Corneal Thickness (CCT) and Intraocular Pressure (IOP) were evaluated preoperatively, 2 weeks, and 6 weeks following CXL.&#x0D; Results : Mean age of patients was 11 (range 6-18 y.o). UCVA were 1.00±0.34 logMAR preoperatively, 0.95±0.35 and 0.88±0.37 logMAR at 2 and 6 weeks after CXL (P=0.27 and P=0.02, respectively). BCVA were 0.37±0.28 logMAR preoperatively, 0.46±0.28 and 0.35±0.21 logMAR at 2 and 6 weeks after CXL (P=0.05 and P=0.46, respectively). Mean IOP were 15.21±3.99 preoperatively, 14.45±2.73 and 15.21±3.68 at 2 weeks and 6 weeks after CXL (P=0.33 and P=1.00, respectively). Mean CCT were 503.09±49.43 preoperatively, 508.18±47.68 and 506.82±48.41 at 2 weeks and 6 weeks after CXL (P=0.01 and P=0.11, respectively). No complications occurred during the observation period.&#x0D; Conclusion : UCVA and BCVA were improved after CXL. Analysis showed no significant change for IOP and CCT after CXL procedure. Overall, CXL was safe and significantly improve UCVA and BCVA in pediatric keratoconus.

Detecting Keratoconus in Primary Healthcare: What general practitioners could do?

Introduction : Keratoconus (KC) is a rare eye disorder that causes corneal thinning and visual disturbances. KC prevalence in the pediatric population is 0.16%. Children with keratoconus experience faster disease progression and significant visual impairment at diagnosis, impacting their quality of life. This case report aims to raise awareness and provide knowledge regarding KC for general practitioners.&#x0D; Case Illustration : A 14-year-old male visited a primary healthcare facility complaining of difficulty seeing words on the classroom board for the past year. His best-corrected visual acuity was 6/15 (S-10.25 C-5.25x30) OD and 6/60 (S-25.00 C-2.75x150) OS. Upon examination, it was observed that the left cornea was more protruding than the right, with a positive Rizzuti and Munson sign. Based on the findings, the patient was suspected of having keratoconus with amblyopia and was referred to an ophthalmologist for further examination and management.&#x0D; Discussion : Keratoconus is severe and burdensome to society, impacting children's education and quality of life. Early detection and intervention are crucial to prevent worsening. KC can be detected in primary healthcare by observing external signs such as Rizzuti and Munson. KC can lead to severe vision problems and even amblyopia if left untreated. Treating pediatric KC involves improving vision using contact lenses. In cases where contact lenses cannot be used, keratoplasty may be necessary.&#x0D; Conclusion : Primary healthcare providers can identify and assess keratoconus in patients and make referrals to ophthalmologists for treatment to minimize the impact on vision and stop its progression.

Paediatric CXL myths and reality

Paediatric keratoconus is often an undiagnosed condition that results in many cases being untreated. As this patient population has a vulnerable developing visual system, a delay in treatment can lead to lifelong visual consequences. Published studies demonstrate that keratoconus progresses at a faster rate in children compared to adults and that CXL can arrest disease progression also in paediatric patients. Current barrier to the CXL treatment may be partly due to the lack of compliance during a procedure performed using local anaesthesia. In addition, children may not comply with instructions to avoid eye rubbing that increases the risk of regression over time and the chance for postoperative infection.

Machine learning analysis with the comprehensive index of corneal tomographic and biomechanical parameters in detecting pediatric subclinical keratoconus.

Background: Keratoconus (KC) occurs at puberty but diagnosis is focused on adults. The early diagnosis of pediatric KC can prevent its progression and improve the quality of life of patients. This study aimed to evaluate the ability of corneal tomographic and biomechanical variables through machine learning analysis to detect subclinical keratoconus (SKC) in a pediatric population. Methods: Fifty-two KC, 52 SKC, and 52 control pediatric eyes matched by age and gender were recruited in a case-control study. The corneal tomographic and biomechanical parameters were measured by professionals. A linear mixed-effects test was used to compare the differences among the three groups and a least significant difference analysis was used to conduct pairwise comparisons. The receiver operating characteristic (ROC) curve and the Delong test were used to evaluate diagnostic ability. Variables were used in a multivariate logistic regression in the machine learning analysis, using a stepwise variable selection to decrease overfitting, and comprehensive indices for detecting pediatric SKC eyes were produced in each step. Results: PE, BAD-D, and TBI had the highest area under the curve (AUC) values in identifying pediatric KC eyes, and the corresponding cutoff values were 12μm, 2.48, and 0.6, respectively. For discriminating SKC eyes, the highest AUC (95% CI) was found in SP A1 with a value of 0.84 (0.765, 0.915), and BAD-D was the best parameter among the corneal tomographic parameters with an AUC (95% CI) value of 0.817 (0.729, 0.886). Three models were generated in the machine learning analysis, and Model 3 (y = 0.400*PE + 1.982* DA ratio max [2mm]-0.072 * SP A1-3.245) had the highest AUC (95% CI) value, with 90.4% sensitivity and 76.9% specificity, and the cutoff value providing the best Youden index was 0.19. Conclusion: The criteria of parameters for diagnosing pediatric KC and SKC eyes were inconsistent with the adult population. Combined corneal tomographic and biomechanical parameters could enhance the early diagnosis of young patients and improve the inadequate representation of pediatric KC research.

Whole-Exome Sequencing of 24 Spanish Families: Candidate Genes for Non-Syndromic Pediatric Keratoconus.

Keratoconus is a corneal dystrophy that is one of the main causes of corneal transplantation and for which there is currently no effective treatment for all patients. The presentation of this disease in pediatric age is associated with rapid progression, a worse prognosis and, in 15-20% of cases, the need for corneal transplantation. It is a multifactorial disease with genetic variability, which makes its genetic study difficult. Discovering new therapeutic targets is necessary to improve the quality of life of patients. In this manuscript, we present the results of whole-exome sequencing (WES) of 24 pediatric families diagnosed at the University Hospital La Paz (HULP) in Madrid. The results show an oligogenic inheritance of the disease. Genes involved in the structure, function, cell adhesion, development and repair pathways of the cornea are proposed as candidate genes for the disease. Further studies are needed to confirm the involvement of the candidate genes described in this article in the development of pediatric keratoconus.

Corneal Collagen Cross-Linking for Progressive Keratoconus in Pediatric Patients: Up to 14 Years of Follow-up

To assess the long-term outcomes of corneal collagen cross-linking according to the Dresden protocol (S-CXL) in progressive pediatric keratoconus (KC). Retrospective, single-center noncomparative interventional study. Patients aged <18 years who underwent S-CXL from June 2007 to January 2011 in Humanitas Clinical and Research Center, Rozzano, Milan, Italy, and completed at least 10 years of follow-up were included. Corrected distance visual acuity (CDVA), refraction, and tomography were evaluated at baseline and ≥10 years after S-CXL. Meeting 2 of the following 3 criteria indicated reprogression: progression above 95% CI for post-CXL population of A or B values or a decrease in minimal thickness C evaluated with the ABCD display. Thirty-eight eyes of 24 patients fulfilled inclusion criteria. At a mean of 11.6 years postoperation (maximum 14 years), the CDVA improved significantly (from 0.703 ± 0.33 decimal fraction to 0.887 ± 0.2, P < .001). Similarly, the A value significantly improved from 2.550 ± 1.7 to 1.627 ± 1.68 (P=.019). Thirteen eyes (34%) showed significant postoperative progression in 2 of the 3 parameters A, B, and C. Of these, only 3 eyes (7.9%) of 3 patients showed a statistically significant change in the A value. S-CXL proved to be a safe treatment for progressive KC in pediatric patients with an anterior curvature progression rate of up to 7.9% at ≥10 years of follow-up.

Association between keratoconus and allergic conjunctivitis in children attending a Tertiary Hospital in Nigeria.

Objective: To ascertain an association between keratoconus and allergic conjunctivitis and to know if it is necessary to investigate all patients with allergic conjunctivitis for keratoconus. Methods: A hospital-based prospective study in which the eyes of children presenting with ocular allergic diseases were examined. Social demographics and clinical data were captured in a questionnaire. All the patients underwent keratometry using the autorefractor-keratometer and the pachymeter was used to measure the central corneal thickness. Data analysis was done with IBM SPSS version 28 for Windows. Frequency and chi-square were used as descriptive statistics to determine the association between dependent and independent variables. Inferential statistics using one-way ANOVA and t-test. P - Value at <0.05 was considered statistically significant. Results: 121 children with allergic conjunctivitis were reviewed. Males were 72 and females 49. The visual acuity was 6/ 6-6/ 18 in 116, and mild visual impairment - 6/ 18-6/ 60 in 5. The most common complaint was frequent itching in 109 (90.1%). Keratometry was normal in 120 (99.5%), while probable keratoconus was found by keratometry in only one patient (0.5%). Central corneal thickness was within the normal range in 33 (27.3%) children, 43 (35.5%) had thin corneas, while 45 (37.2%) had cornea thickness of more than 560 microns. Discussion: Pediatric keratoconus tends to be more aggressive than adult keratoconus with an increased risk of corneal opacities and subsequent keratoplasty. As a result of these negative impacts, early detection and prompt treatment are mandatory. Conclusion: The prevalence of keratoconus was not found to be high in this study population, but with facts emerging between the association of allergic conjunctivitis, and increased prevalence of keratoconus, it is pertinent to integrate keratoconus screening as part of the management of allergic conjunctivitis using an appropriate tool such as video keratography and slit lamp biomicroscope. Abbreviations: KC = Keratoconus, CLEK = Collaborative Longitudinal Evaluation of Keratoconus, SAC = Seasonal Allergic Conjunctivitis, PAC = Perennial Allergic Conjunctivitis, VKC = Vernal Keratoconjunctivitis, IOP = Intraocular Pressure, CCT = Central Corneal Thickness, TNF-α = Tumor Necrosis Factor-Alpha, IL = Interleukin.

Clinical Results of Accelerated Iontophoresis-Assisted Epithelium-on Corneal Cross-linking for Progressive Keratoconus in Children.

To evaluate the clinical characteristics of pediatric patients with progression of keratoconus after accelerated iontophoresis-assisted epithelium-on corneal cross-linking (I-ON CXL) and to assess the efficacy and safety of re-treatment using accelerated epithelium-off CXL (epi-OFF CXL). Sixteen eyes of 16 patients (mean age: 14.6 ± 2.5 years) with keratoconus underwent I-ON CXL. The main outcome measures were uncorrected distance visual acuity, corrected distance visual acuity, maximum keratometry index (Kmax), minimum corneal thickness, elevation front and elevation back measured at the thinnest point, total higher order aberrations root main square (HOA RMS), coma RMS, and spherical aberration. An increment of Kmax greater than 1.00 diopter (D) and a decrease of greater than 20 µm in pachymetry were considered to determine the progression of keratoconus. Patients with progression of keratoconus after I-ON CXL were re-treated using an epi-OFF CXL protocol. Two years after I-ON CXL, 12 patients showed progression of keratoconus, whereas 4 patients were stable. There was significant worsening of Kmax (P = .04) and steepest keratometric reading (P = .01). Furthermore, a significant correlation was documented between progression of keratoconus and age (P = .02). These patients were re-treated using an epi-OFF protocol and after 2 years all patients were stable, and a statistically significant reduction of the mean Kmax (P = .007), HOA RMS (P = .05), and coma RMS (P = 05) was observed. I-ON CXL was ineffective in the treatment of pediatric keratoconus in younger children, whereas it had an efficacy of 2 years in older children. Re-treatment using epi-OFF CXL proved effective to halt progression of keratoconus after I-ON CXL failure. [J Pediatr Ophthalmol Strabismus. 2024;61(1):44-50.].

Outcome indicators for cross linking in pediatric keratoconus.

To evaluate the predictive factors for successful corneal collagen cross-linking (CXL) in pediatric patients with Keratoconus (KC). This retrospective study was conducted using a prospectively built database. Patients (18 years old or younger) underwent CXL for KC between 2007 and 2017, with a 1-year follow-up period or longer. The outcomes included changes in Kmax (delta [Δ] Kmax = Kmaxlast - Kmaxpre) and LogMAR visual acuity (ΔLogMAR = LogMARlast - LogMARpre).The effects of CXL type (accelerated or non-accelerated), demographics (age, sex, background of ocular allergy, ethnicity), preoperative LogMAR visual acuity, maximal corneal power (Kmax), pachymetry (CCTpre), refractive cylinder, and follow-up (FU) time on the outcomes were analyzed. One hundred thirty-one eyes of 110 children were included (mean age, 16 ± 2 years; range, 10-18 years). Kmax and LogMAR improved from baseline to last visit: from 53.81 D ± 6.39 D to 52.31 D ± 6.06 D (p < 0.001) and from 0.27 ± 0.23 LogMAR units to 0.23 ± 0.19 LogMAR units (p = 0.005), respectively. A negative ΔKmax (meaning corneal flattening) was associated with a long FU, low CCTpre, high Kmaxpre, high LogMARpre, and non-accelerated CXL on univariate analysis. High Kmaxpre and non-accelerated CXL were associated with negative ΔKmax in the multivariate analysis.A negative ΔLogMAR (meaning vision improvement) was associated with a high LogMARpre in univariate analysis. CXL is an effective treatment option in pediatric patients with KC. Our results showed that the non-accelerated treatment was more effective than the accelerated treatment. Corneas with advanced disease had a greater effect on CXL.

Analysis of the outcomes of three different cross-linking protocols for treatment of paediatric keratoconus: A multicentre randomized controlled trial.

To analyse long-term outcomes of standard cross-linking (SCXL), accelerated cross-linking (ACXL) and transepithelial cross-linking (TCXL) in the treatment of progressive paediatric keratoconus regarding stability, safety and efficacy. This prospective multicentre randomized controlled trial included 97 eyes of 97 paediatric patients with stages I-III ABCD keratoconus grading system, who were randomized into three groups; SCXL group (control group, n = 32; 3 mW/cm2 × 30 min/5.4 J/cm2 ), ACXL (n = 33; 18 mW/cm2 × 5 min/5.4 J/cm2 ) and TCXL (n = 32; 18 mW/cm2 × 5 min/5.4 J/cm2 ). Subjective refraction, uncorrected and corrected visual acuity, keratometry and pachymetry measurements using corneal topography were recorded preoperatively and 1, 2 and 3 years postoperatively. SCXL group exhibited significant successive improvements in the mean visual, refractive and keratometric parameters throughout the entire postoperative 3 years while ACXL group exhibited significant improvements in visual and keratometric parameters in the first postoperative year that remained stable in second and third postoperative years. TCXL group exhibited significant progressive deterioration in all mean parameters compared to SCXL and ACXL (p < 0.0001). Both SCXL and ACXL revealed final 100% success rate with good stability while TCXL revealed final 22% failure rate with keratoconus progression (p < 0.0001). SCXL and ACXL were comparable in halting keratoconus progression and achieved good stability and safety; however, SCXL was more efficient than ACXL as it yielded greater significant postoperative mean visual, refractive and keratometric improvements achieving smoother corneal remodelling. Both SCXL and ACXL were much superior to TCXL. SCXL is the best CXL treatment option for paediatric keratoconus while ACXL is a good and effective alternative.

Outcomes of accelerated collagen cross linking in progressive paediatric keratoconus.

To determine the efficacy and safety of pediatric accelerated cross linking (CXL). A prospective study on progressive keratoconus (KC) cases under ≤18 years of age. Sixty four eyes of thirty nine cases underwent epithelium-off accelerated CXL protocol. Visual acuity (VA), slit-lamp examination, refraction, pentacam reading of keratometry (K), corneal thickness, and thinnest location pachymetry were noted. Cases were followed up on days 1, 5, and at 1st, 3rd, 6th, and 12th-month post procedure. Statistically, significant improvement of the mean aided VA, K, and mean corneal astigmatism (p < 0.0001) was noted. Mean Kmax reading reduced from 55.5 ± 5.64 (47.4-70.4) diopter (D) preoperatively to 54.41 ± 5.51 (46-68.3) D at 12 months postaccelerated CXL. Two cases had progression. Complications encountered were sterile infiltrate and persistent haze. Accelerated CXL is effective and efficacious in pediatric KC.

The Keratectasia Volume (KEV) in Corneal Topography to Evaluate the Effect of Corneal Collagen Cross-linking in Pediatric Keratoconus.

The study aimed to evaluate the keratectasia volume (KEV) before and after corneal cross-linking (CXL) in pediatric patients. This study included 40 eyes of 25 pediatric patients (10-19years) undergoing standard CXL. The support vector machine (SVM) algorithm was applied to transform mass pixels in corneal topography into a three-dimensioned model to calculate the KEV. The KEV, Kmax, K1, K2, Kave, keratectasia area (KEA), and thinnest corneal thickness (TCT) were determined before CXL and at 3, 6, and 12months after surgery. The correlation between KEV and other parameters (Kmax, TCT, max decentration, eccentricity, and so on) was calculated. The KEV was 4.75 ± 0.74 preoperatively and 4.43 ± 1.22 postoperatively at last follow-up (p < 0.002). There was strong positive correlation between the KEV and Kmax (r = 0.806, p < 0.0005). The preoperat ive KEV was 4.32 ± 0.69 in mild to moderate keratoconus (Kmax < 58D) and 5.27 ± 0.37 in advanced keratoconus (Kmax > 58D) (p < 0.0005, t-test). Postoperative KEV and K readings remained stable at the early stage, and the KEV showed a more drastic decreasing trend than Kmax at sixth month. Statistical significance was found in the KEV between preoperative and 6months after surgery (p < 0.0005), but not in Kmax and other parameters. In 83.3% (15 eyes out of 18 eyes) of the eyes, the preoperative KEV was greater than 4.6 in patients with significant flattening after CXL. Compared with K readings, the KEV can be regarded as a more sensitive index to evaluate the postoperative morphological changes after CXL in pediatric patients.

Natural history and predictors for progression in pediatric keratoconus

We studied the demographic and clinical predictors associated with keratoconus progression in a pediatric population. Retrospective cohort study. We evaluated 305 eyes without previous surgeries from 168 patients, 9 to < 18 years old, and with a minimum 36-month follow-up in a hospital corneal ambulatory. We used Kaplan-Meyer survival curves; the dependent variable (main outcome measure) was the interval time (months) until the event, defined as an increase of 1.5 D in the maximum keratometry (Kmax), obtained with Pentacam. We evaluated the predictors: age (< or ≥ 14 years), sex, keratoconus familial history, allergy medical history, and the baseline tomographic parameters: mean keratometry (Km), Kmax (< or ≥ 55 D); and thinnest pachymetry (TP). We used log-rank tests and compared median survival times for right (RE)/left eyes (LE) and better (BE)/worse eyes (WE). A p value < 0.05 was considered significant. The patients’ mean ± SD age was 15.1 ± 2.3 years old; 67% were boys, 30% were < 14 years, 15% had keratoconus familial history, and 70% were allergic. The general Kaplan-Meyer curves showed no differences between RE/LE or BE/WE. RE with allergy and LE with Kmax ≥ 55 D had smaller survival times ((95%CI 9.67–32.1), p 0.031 and (95%CI 10.1–44.1), p 0.042, respectively). For BE and WE, Kmax ≥ 55 D had smaller survival times ((95% CI 6.42- ), p 0.031 and (95%CI 8.75–31.8), p 0.043, respectively). Keratoconus progression was similar between RE/LE and BE/WE. Steepest corneas are predictors of faster progression. Allergy is also a predictor of keratoconus progression in RE.

Keratoconus in pre-teen children: Demographics and clinical profile.

To study the demographics and clinical profile of keratoconus (KC) presenting in pre-teen children in India. This was a retrospective case series conducted as a single-institutional study at a tertiary eye center in India. A total of 586 eyes from 294 KC patients (aged 12 years or less) without any active comorbid conditions of the eye were included in the study. Slit-lamp biomicroscopy was used to document the clinical signs of KC. Information on age; gender; reason for consultation; family history; history of allergy, atopy, and eye rubbing; manifest refraction; uncorrected and best-corrected distance visual acuity (UCVA and BCVA, respectively); clinical presentation; and contact lens usage were also analyzed, along with data on types of medical and surgical treatments for KC and their outcomes. The mean age of this pediatric KC patient cohort was 9.3 ± 1.8 years, and there was a male (70%) preponderance. Baseline mean UCVA, BCVA, steep keratometry, and flat keratometry were 0.86 ± 0.58 logMAR, 0.44 ± 0.38 logMAR, 54.82 ± 8.4 D, and 48.21 ± 9.5 D, respectively. Progression, necessitating collagen crosslinking (CXL), was noted in 12.7% eyes. Post-CXL, visual and topographic parameters remained stable without any complications till 6 months posttreatment. However, in eyes that did not undergo CXL, significant progression over time (P < 0.001) was observed. A keratoplasty was required in 2.3% eyes. KC was present at an advanced stage in 25% of the pre-teens in our series, and therefore, it is an important diagnostic entity when a refractive error is diagnosed, even in very young children.

Parental Keratoconus Literacy: A Socioeconomic Perspective.

PurposeTo assess the impact of parental socioeconomic status and keratoconus literacy on pediatric eye rubbing and keratoconus severity.MethodsIn this mixed-methods study, pediatric keratoconus patients (age ≤ 18 years) were retrospectively identified. Sociodemographic and clinical characteristics were extracted from the electronic medical record (EMR). Telephone surveys were subsequently conducted to assess parental keratoconus literacy, receipt of counseling on keratoconus prevention, eye rubbing, and household socioeconomic factors not available in the EMR. Parents reporting poor keratoconus literacy were probed via semi-structured interview to explore barriers to their understanding.ResultsForty-eight patients met inclusion criteria, 22 (46%) of whom were reached by telephone. Most patients were insured by Medicaid (73%) and current eye rubbers (82%). Few parents reported good or excellent keratoconus literacy now (32%) or at the time of diagnosis (18%). Parents with a high-school education, limited English proficiency, lower income level, and Medicaid insurance tended to have lower keratoconus literacy, though this was not statistically significant. Parental keratoconus literacy was not correlated with disease severity. High-school education, limited English proficiency, lower income level, and Medicaid insurance were correlated with steeper keratometry readings, which was statistically significant for high-school education. In-depth interviews revealed parents felt unconfident with eye health in general and perceived a personal responsibility for learning more.ConclusionThis is the first study exploring keratoconus literacy from a socioeconomic perspective, demonstrating lower literacy among socioeconomically marginalized parents and a tendency toward more severe disease in their children.

Distribution of pediatric keratoconus by different age and gender groups.

PurposeTo evaluate the distribution of pediatric keratoconus patients and the disease severity based on different age and gender groups in China.Materials and methodsA total of 446 keratoconus eyes in 266 pediatric patients from January 2019 to January 2022 were included in the cross-sectional study. The clinical findings and severity of keratoconus were recorded and Kruskal–Wallis test, chi-squared test, and Cochran-Mantel-Haenszel (CMH) test were used to compare the parameters between different gender and age groups.ResultsThe male/female ratio was 353/93 (3.8:1), and the median age was 16 years (range: 6–17 years). Male patients were statistically younger than female patients (P = 0.041). The male/female ratio decreased with age (P for trend = 0.011). The distribution of the topographic keratoconus classification (TKC) stage was significantly different between gender and age groups (all P < 0.05). Male patients had a higher ratio of advanced keratoconus eyes (TKC ≥ 3) than female patients (P < 0.001), and CMH analysis indicated that being a male was a risk factor for advanced keratoconus after controlling for age (odds ratio: 2.581, P < 0.001).ConclusionMale keratoconus patients were younger, with a higher ratio of advanced keratoconus than female patients in the Chinese pediatric patients evaluated. Multicenter studies with larger sample sizes are necessary in the future.