Association between diabetes and keratoconus—a systematic review and meta-analysis

Akowuah, Prince Kwaku; Arthur, Christabel; Otabil, Fredrick Annan; Ofori, Collins A; Osei-Poku, Kofi; Fummey, Jeremiah; Boadi, Prince; Dadzie, Emmanuella Esi

doi:10.1177/11206721211053167

Cited by 4 publications

(4 citation statements)

References 54 publications

(63 reference statements)

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“…Furthermore, a potential correlation between diabetes mellitus as systemic comorbidity and KCN is a much debated topic in the current literature. 30–32 Although type 2 diabetes mellitus has been found to be potentially correlated with KCN, 32 only a small percentage of patients in our cohort had DM. This would be consistent, however, with a recent systematic review and meta-analysis that found no correlation between diabetes and KCN.…”

Section: Discussionmentioning

confidence: 76%

“…This would be consistent, however, with a recent systematic review and meta-analysis that found no correlation between diabetes and KCN. 30 Our study is not without limitations. Although the first documented visit in the EHR was designated as a patient's baseline presentation, many of these patients may have had a history of KCN before the initial presentation to our institution, which has multiple sites including the community and tertiary care hospital-based referral centers.…”

Section: Discussionmentioning

confidence: 84%

“…This would be consistent, however, with a recent systematic review and meta-analysis that found no correlation between diabetes and KCN. 30…”

Section: Discussionmentioning

confidence: 99%

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Racial Variation in Visual Impairment of Patients With Keratoconus at Presentation

Nugent¹,

Son

Wang

et al. 2023

Cornea

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Purpose:This study aimed to investigate racial disparities in the severity of keratoconus (KCN) at presentation, their intersection with socioeconomic variables, and other factors associated with visual impairment.Methods:This retrospective cohort study examined medical records of 1989 patients (3978 treatment-naive eyes) with a diagnosis of KCN seen at Wilmer Eye Institute between 2013 and 2020. A multivariable regression model adjusting for age, sex, race, insurance type, KCN family history, atopy, smoking status, and vision correction method examined factors associated with visual impairment, defined as a best available visual acuity of worse than 20/40 in the better eye.Results:Demographically, Asian patients were the youngest (33.4 ± 14.0 years) (P < 0.001), and Black patients had the highest median area deprivation index (ADI) of 37.0 [interquartile range (IQR): 21.0–60.5] (P < 0.001). Multivariable analysis showed a higher risk of visual impairment for Black (OR 2.25, 95% CI, 1.71–2.95) versus White patients. Medicaid (OR 2.59, 95% CI, 1.75–3.83) and Medicare (OR 2.48, 95% CI, 1.51–4.07) were also associated with a higher odds of visual impairment compared with private insurance, and active smokers were more likely to have visual impairment than those with no prior smoking history (OR 2.17, 95% CI, 1.42–3.30). Eyes of Black patients had the highest maximum keratometry (Kmax) (56.0 ± 11.0D) (P = 0.003) and the lowest thinnest pachymetry (463.2 ± 62.5 µm) (P = 0.006) compared with eyes of other races.Conclusions:Black race, government-funded insurance, and active smoking were significantly associated with increased odds of visual impairment in adjusted analyses. Black race was also associated with higher Kmax and lower thinnest pachymetry, suggesting that Black patients have more severe disease at presentation.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 84%

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Racial Variation in Visual Impairment of Patients With Keratoconus at Presentation

Nugent¹,

Son

Wang

et al. 2023

Cornea

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“…Recently, several meta-analyses have examined the association between keratoconus and diabetes. One such analysis examined 6 case–control studies and 3 cohort studies and found no significant association between keratoconus and DM, with an odds ratio of 0.87 and a 95% confidence interval of 0.66–1.14 [ 125 ]. Another meta-analysis examining 2 additional case–control studies for a total of 8 case–control and 3 cohort studies also determined no significant association between keratoconus and DM, with an odds ratio of 0.83 and 95% confidence interval of 0.66–1.10 [ 126 ].…”

Section: Resultsmentioning

confidence: 99%

Systemic Associations with Keratoconus

Unni

Lee

2023

Life

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Keratoconus is a disease of the cornea that results in progressive steepening and thinning of the cornea and subsequent vision loss. It nearly always presents as a bilateral disease, suggesting that there is an underlying abnormality of the corneas that becomes manifest with time. However, the mechanisms underlying the development of keratoconus are largely unknown. Associations reported between keratoconus and systemic diseases are abundant in the literature, and the list of possible associations is very long. We found that atopy, Down syndrome, and various connective tissue diseases were the most frequently cited associations in our broad literature search. Additionally, Diabetes Mellitus has been increasingly studied as a possible protective factor against keratoconus. In this review, we have summarized the evidence for and against these particular systemic conditions and keratoconus and have discussed some of the implications of keratoconus patients having these conditions.

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