Predictors of progression in untreated keratoconus: a Save Sight Keratoconus Registry study

Abstract

AimsWe set out to identify risk factors for progression in untreated keratoconus patients from 34 centres across Australia, New Zealand, Spain and Italy.MethodsPatients were divided into ‘progressors’ and ‘stable’ patients for each clinical parameter: visual acuity (VA), steepest keratometry (maximum keratometry (Max-K)) and thinnest corneal thickness (TCT). Primary outcomes were the proportion of eyes with sustained progression in VA, Max-K or TCT within 3 years. Secondary outcomes included predictors of progression.ResultsThere were 3994 untreated eyes from 2283 patients. The proportion of eyes with VA, Max-K and TCT progression at 1 year were 3.2%, 6.6% and 3.1% respectively. Factors associated with VA loss were higher baseline VA (HR 1.15 per logMAR line increase in VA; p<0.001) and steeper baseline Max-K (HR 1.07 per 1D increase; p<0.001). Younger baseline age was associated with Max-K steepening (HR 0.96 per year older; p=0.001). Thicker baseline TCT, steeper baseline Max-K and younger baseline age were associated with TCT thinning: (HR 1.08 per 10 µm increase in TCT; p<0.001), (HR 1.03 per 1D increase; p=0.02) and (HR 0.98 per year younger; p=0.01), respectively.ConclusionsSteeper Max-K and younger age were the most clinically useful baseline predictors of progression as they were associated with worsening of two clinical parameters. Every 1D steeper Max-K was associated with a 7% and 3% greater risk of worsening VA and thinning TCT, respectively. Each 1 year younger was associated with a 4% and 2% greater risk of steepening Max-K and thinning TCT, respectively.

Quality of life impact of eye diseases: a Save Sight Registries study

“…The study had several strengths. Our large cohort of routine clinical practice data from multiple international sites likely reflects the QoL impact of eye diseases in the real world 29–32 . This study has confirmed that the use of IVI in SSR modules is appropriate, and misguided or false conclusions are not derived from the future IVI use in the registry.…”

“…This descriptive, cross‐sectional study was conducted using the prospectively designed SSR database (http://savesightregistries.org/). The SSR is a multi‐national web‐based database of patients with eye diseases that allows routine collection of clinical and patient‐reported data and monitoring of outcomes over time 29–32 . The current study included the participants from 44 practices with an established diagnosis of keratoconus, AMD, RVO or DME in one or both eyes who self‐administered the IVI questionnaire.…”

Crosslinking vs. Observation in Fellow Eyes of Keratoconus Patients

“…Keratoconus tends to progress more rapidly in younger subjects and has been shown to plateau with age [ 6 , 14 , 15 , 33 , 34 ]. The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study evaluating the natural history of keratoconus reported that a presenting age younger than 35 years is a significant predictor of a 3D or more increase in K1 [ 34 ].…”

“…Corneal topography, tomography, and pachymetry are the principal parameters used in the diagnosis and follow-up of progressive KC [ 5 ]. Numerous studies have identified baseline corneal characteristics that are associated with more severe disease and progression in these parameters [ 6 , 14 , 15 , 33 , 38 ]. In a study evaluating prognostic factors of KC progression that led to corneal transplantation, Tuft et al found that eyes with steeper baseline K1 and K2 required a shorter time to penetrate keratoplasty [ 33 ].…”

“…In a study evaluating prognostic factors of KC progression that led to corneal transplantation, Tuft et al found that eyes with steeper baseline K1 and K2 required a shorter time to penetrate keratoplasty [ 33 ]. Ferdi et al described that thicker baseline pachymetry and steeper baseline Kmax were associated with disease progression over the follow-up period [ 15 ]. Choi et al additionally reported thinnest pachymetry <350 μ m alongside an increase of ≥0.15D/year in Kmax, ≥0.2D/year in minimum keratometry, and ≥0.1D/year in central keratometry to significantly correlate with KC progression [ 6 ].…”