American Journal of Ophthalmology, November 2021
Thanitcul et al. conducted a review to uncover factors linked to higher or lower odds of a patient receiving keratoplasty for keratoconus. They found that young adults, patients with corneal hydrops, and residents of western regions of the United States were more likely to undergo keratoplasty. In contrast, the likelihood of keratoplasty was lower in individuals who had used contact lenses, had a history of glaucoma, or resided in the Northeast.
For this cross-sectional study, the authors reviewed medical records of patients with keratoconus who were <65 years of age. They obtained these records from the IBM MarketScan Database and focused on inpatient and outpatient claims made from 2010 through 2018. They developed a model, which was adjusted for potential confounders, to identify sociodemographic and comorbid factors associated with lower and higher likelihood of keratoplasty.
Of the 42,086 patients identified, 1,282 (3%) had undergone keratoplasty. According to the fully adjusted analysis, the likelihood of keratoplasty was lower for women (odds ratio [OR], 0.87) and for patients in metropolitan areas (OR, 0.75). The authors surmised that the regional trends may relate to access to fitting services for specialty contact lenses and to the effects of different climates on contact lens tolerability. With respect to age, patients in their 20s or 30s were more likely to receive keratoplasty than were younger patients (OR, 1.77 and 1.61, respectively). There was no difference between the youngest and oldest patients (10-19 and 50-64 years, respectively). Keratoplasty was less common among those who had worn contact lenses (OR, .61) or had a history of glaucoma (OR, .60). It was more common in patients with hydrops (OR, 4.87), Leber congenital amaurosis (LCA; OR, 2.41), sleep apnea (OR, 1.46), diabetes (OR, 1.32), or depression (OR, 1.22).
Several predictors of keratoplasty noted in this study had not been identified previously, including LCA, depression, and diabetes. According to the authors, this information may help clinicians identify patients who need frequent monitoring or may be candidates for early interventions such as corneal cross-linking.
The original article can be found here.