The Aotearoa Research Into Keratoconus Study: Geographic Distribution, Demographics, and Clinical Characteristics of Keratoconus in New Zealand

Abstract

was completed for every patient with keratoconus who underwent a consultation with participating optometrists in a 2-year period. Data for each patient included date of birth, sex, self-reported ethnicity, new or previous diagnosis, uncorrected (UCVA) and best-corrected visual acuity (BCVA), type of refractive correction required to obtain BCVA and keratometric readings obtained using keratometry or computerized topography.Results: One thousand eight hundred sixty-nine cases were identified, with a mean age of 41.0 6 15.7 years, 56.4% being men, and 87.3% with previous diagnosis. The distribution of cases was skewed toward Auckland (41.6%), Waikato (21.3%), Wellington (16.8%), and Bay of Plenty (13.3%). Self-reported ethnicities were predominantly NZ European (54.4%), M aori (24.7%), and Pacific Peoples (15.5%), disproportionate to the general population profile (74.0%, 14.9%, and 7.4% respectively). Most eyes (64.3%) were managed with rigid contact lenses (corneal lens in 34.2%). The mean K-mean was 49.0 6 5.7 D. The mean UCVA was 6/42 and BCVA was 6/9. M aori and Pacific Peoples had both the highest K-mean and proportions of eyes graded stage IV on the Amsler-Krumeich scale. Conclusions:The results indicate that keratoconus is relatively common in NZ with at least 1869 patients managed by optometrists in 2 years. Most eyes had mild to moderate disease; however, M aori and Pacific Peoples seem to have greater disease severity. An ethnic predilection is apparent, with M aori and Pacific Peoples overrepresented relative to their population proportions, reinforcing a long-held clinical suspicion.

Changing Trends in Corneal Transplantation in Aotearoa/New Zealand, 1991 to 2020: Effects of Population Growth, Cataract Surgery, Endothelial Keratoplasty, and Corneal Cross-Linking for Keratoconus

“…Previous studies on keratoconus in NZ have assessed demographics, tomographic features, and disease severity of sample populations of high school students, 18 tertiary care centers, 26,27 and optometrists. 27,28 Although not absolutely conclusive, these studies support the widely held suspicion that keratoconus is more common in both New Zealand and the Māori and Pasifika populations. Currently, CXL for keratoconus exceeds keratoplasty for keratoconus in NZ by at least a factor of 8 but ultimately a longer study period since the introduction of CXL is required to fully investigate the long-term effects on keratoplasty rates.…”

Hauora Maaori o ngaa karu: Maaori ocular health review

“…Regarding access to care, studies have found that Maaori are more likely to present to an ophthalmologist at a later stage of disease for conditions such as cataract, keratoconus and diabetic retinopathy compared to non-Maaori. 8,9,11 This highlights issues regarding access and presentation to services for Maaori which perpetuate inequity. Disparities in accessing care and ocular disease severity impact Maaori individuals, whaanau and communities.…”

“…Keratoconus, a corneal condition, is also more common and severe in Maaori and Pacific individuals throughout Aotearoa, with evidence indicating only 50% of Maaori attend their first specialist appointment. 17 This is inequitable when considering that 90% of Asian and European patients attend their first specialist appointment for keratoconus. 17 This again highlights emerging evidence of Maaori ocular health outcome and access inequities in Aotearoa.…”

“…17 This is inequitable when considering that 90% of Asian and European patients attend their first specialist appointment for keratoconus. 17 This again highlights emerging evidence of Maaori ocular health outcome and access inequities in Aotearoa.…”

“…[4][5][6][7] Ocular health outcomes are not spared from this trend, with Maaori experiencing higher rates of diabetic retinopathy, cataract, ocular trauma, and keratoconus when compared to non-Maaori. 8,9 The United Nations have formally recognised Indigenous health inequity and called for societal reform which is culturally and linguistically appropriate, and have thereby created an international responsibility to ensure that the health of Indigenous populations is protected. 3 In response to this, several Indigenous ocular healthcare delivery models have been developed and implemented.…”