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  • Cornea/External Disease

    Review of: Trends and sociodemographic patterns in keratoconus management 2015–2020

    Syed Z, Tomaiuolo M, Zhang Q, et al. Ophthalmology, in press 2024

    More patients in the United States appear to be receiving treatment for keratoconus (KCN) since FDA approval of corneal crosslinking (CXL) in 2016, and they are being diagnosed earlier, but different trends seen among patients of different race/ethnicity or insurance status (among other factors) suggest associations between certain sociodemographic factors and access to treatment or care.

    Study Design

    In this retrospective cohort study, investigators examined changing trends in KCN with respect to diagnosis and treatment using information extracted from the Academy IRIS (Intelligent Research in Sight) Registry. Data from 66,199 individuals with a new diagnosis of KCN between 2015 and 2020 were included.


    Over the 5-year study period, there was a decrease in age at the time of diagnosis (44.1 years to 39.2 years) and an increase in the percentage of patients undergoing CXL (0.05% to 29.5%) while the percentage of patients undergoing keratoplasty remained relatively stable. Individuals who underwent CXL were younger than their counterparts who did not undergo CXL, and males were more likely to undergo both CXL (OR 1.31) and keratoplasty (OR 1.30) compared to females. Black patients were less likely than White patients to have CXL (OR 0.70) but more likely to have keratoplasty (OR 2.24). Patients in the West or Midwest were more likely to have CXL than those in the South (OR 1.45 and 1.33, respectively); odds of undergoing CXL (OR 0.67) or keratoplasty (OR 0.62) were lower in patients who lived in the Northeast. Individuals with Medicaid were more likely to undergo keratoplasty (OR 1.81) and less likely to undergo CXL (OR 0.55) than patients with commercial insurance.


    Limitations include the retrospective nature of the study and its reliance on coding to ascertain events of interest.

    Clinical Significance

    This study identifies varying trends in KCN treatment over time and based on patient demographics, insurance, and location. With the goal of KCN treatment being early CXL and a decreased need for keratoplasty, this study identifies groups that may benefit from treatment algorithm optimization, though determining the reasons behind these observed trends will require additional investigation.

    Financial Disclosures: Dr. Anat Galor discloses financial relationships with Allergan, Astrozenica, Dompé, Eyecool, Novaliq GmbH, Novartis Pharma AG, Oculis, Oyster Point Pharma, Shire, Tarsus Pharmaceuticals (Consultant/Advisor).