Distribution of pediatric keratoconus by different age and gender groups

Yang, Kaili; Gu, Yuwei; Xu, Liyan; Fan, Qi; Zhu, Meng; Wang, Qing; Yin, Shanshan; Zhang, Bo; Pang, Chenjiu; Ren, Shuxin

doi:10.3389/fped.2022.937246

Cited by 10 publications

(9 citation statements)

References 41 publications

(87 reference statements)

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“…Some studies have suggested that KCN is a male-predominant disease. 28,30 However, in this study, black men were less likely to present with KCN than non-black men. This could be explained by the theory that black men have less trust in the medical system than other populations, such as black women or white men, 31 making them less likely to present for an evaluation.…”

contrasting

confidence: 57%

A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus

Christensen,

Kartchner,

Giegengack

et al. 2024

OPTH

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Purpose Patients with advanced keratoconus (KCN) are less likely to benefit from corneal cross-linking and may require a partial or full thickness keratoplasty. This study aimed to determine whether racial disparities exist in the clinical presentation and initial treatment recommendations for patients evaluated for KCN. Methods A single-center retrospective review was conducted on all patients who presented to the cornea department for initial evaluation of KCN between 2018 and 2020. Patients who had undergone prior corneal procedures or surgeries were excluded. Baseline sociodemographic and clinical information was collected and stratified according to black versus non-black race. Generalized estimating equations were used to examine the association between black race and presenting corrected distance visual acuity (CDVA), presence of corneal scarring, keratometry values, Belin ABCD score, and treatment recommendations. Multivariate models were adjusted for patient demographics. Results A total of 128 patients (251 eyes) were included in this study. In fully adjusted models, black individuals presented with significantly worse CDVA (p < 0.0001) and worse tomographic KCN staging according to the Belin ABCD criteria (p = 0.002) compared to non-blacks. Blacks were also more than four times as likely to present with a thinnest pachymetry <400 µm (p < 0.0001) and more than three times as likely to have corneal scarring (p = 0.001). Blacks were more than seven times more likely to have keratoplasty recommended as treatment than conservative management such as corneal cross-linking or contact lenses (p = 0.004). Conclusion Compared with their non-black counterparts, blacks presented with significantly more advanced KCN, which placed them at risk of requiring more invasive treatment plans. Future studies should investigate reasons for such late presentations and aim to mitigate disparities in the presentation and management of KCN.

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contrasting

confidence: 57%

A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus

Christensen,

Kartchner,

Giegengack

et al. 2024

OPTH

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“…The limited sample of pediatric SKC eyes would result in a lack of research evidence of the diagnosis criteria of pediatric SKC eyes. In addition, our previous study reported that pediatric unilateral patients account for 7.82% of all KC patients (86/1,100), ( Yang et al, 2022 ), which might be related to the fact that the minimum age approved for corneal refractive surgery is 18 years and corneal tomography and biomechanics are not commonly examined in children. ( Ortega-Usobiaga et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…This case-control study enrolled 52 control eyes, 52 SKC eyes, and 52 KC eyes of individuals aged <18 years between January 2019 and January 2022 in the Henan Eye Hospital. KC was included as per previous criteria: ( Yang et al, 2022 ): an asymmetric bowtie pattern with or without skewed axes, a Belin Ambrosio enhanced ectasia total deviation index (BAD-D) value > 2.6 by corneal topography, and a positive slit-lamp sign (localized stromal thinning, Vogt’s striae, Fleischer’s ring, conical protrusion, or anterior stromal scar). The SKC eye in the current study was defined as no clear evidence of KC in one eye, with the contralateral eye meeting the above KC diagnostic criteria.…”

Section: Methodsmentioning

confidence: 99%

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

Ren,

Yang,

et al. 2023

Front. Bioeng. Biotechnol.

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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 12 μm, 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 [2 mm]−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.

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“…The subjects of the case‒control study were patients from the Henan Eye Hospital during 2019–2022. Details of the design of the case‒control study have been described elsewhere [ 14 , 18 , 19 ]. Briefly, in this study, the participants were recruited based on age (3 years) and sex.…”

Section: Methodsmentioning

confidence: 99%

A high body mass index strengthens the association between the time of eye rubbing and keratoconus in a Chinese population: a case control study

Ren,

Tu,

et al. 2023

BMC Public Health

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Background Although body mass index (BMI) and eye rubbing are linked to an increased risk of keratoconus (KC), the interactive effect of eye rubbing and BMI on KC is largely unknown. This study aimed to evaluate the independent and interactive effects of BMI and eye rubbing on KC and to further explore the role of environmental factors on the occurrence of KC. Methods A total of 621 individuals (291 KC patients and 330 control individuals) were enrolled in this hospital‑based study on KC patients in Central China after individuals missing BMI data were excluded. BMI was calculated as weight in kilograms divided by the square of height in meters. Data on eye rubbing was recorded through face-to-face interviews. Generalized linear regression models were used to analyze associations among BMI, eye rubbing and KC. Interaction plots were used to describe the interactive effects of BMI and eye rubbing on KC. Results The β and 95% confidence interval (CI) were 0.923 (0.112, 1.733) (p = 0.026) and 3.356 (1.953, 4.759) (p < 0.001), respectively, for the effect of each 10 kg/m2 increase in BMI and each 1 min increase in eye rubbing on KC. The interaction of BMI and eye rubbing were positively correlated with KC (p < 0.001). Conclusion These findings suggested that a high BMI aggravated the negative effect of eye rubbing on KC, implying that individuals with a high BMI may be more susceptible to exposure to eye rubbing, which is related to an increased risk of KC.

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Distribution of pediatric keratoconus by different age and gender groups

Cited by 10 publications

References 41 publications

A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus

A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus

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

A high body mass index strengthens the association between the time of eye rubbing and keratoconus in a Chinese population: a case control study

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