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Raiskup F, Herber R, Lenk J, Pillunat LE, Spoerl E. Crosslinking with UV-A and riboflavin in progressive keratoconus: From laboratory to clinical practice - Developments over 25 years. Prog Retin Eye Res 2024; 102:101276. [PMID: 38830532 DOI: 10.1016/j.preteyeres.2024.101276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
Changes in the biomechanical and biochemical properties of the human cornea play an important role in the pathogenesis of ectatic diseases. A number of conditions in primarily acquired (keratoconus or pellucid marginal degeneration) or secondarily induced (iatrogenic keratectasia after refractive laser surgeries) ectatic disorders lead to decreased biomechanical stability. Corneal collagen cross-linking (CXL) represents a technique to slow or even halt the progression of ectatic pathologies. In this procedure, riboflavin is applied in combination with ultraviolet A radiation. This interaction induces the production of reactive oxygen species, which leads to the formation of additional covalent bonds between collagen molecules and subsequent biomechanical corneal strengthening. This procedure is so far the only method that partially interferes etiopathogenetically in the treatment of ectatic diseases that slows or stops the process of corneal destabilization, otherwise leading to the need for corneal transplantation. Besides, CXL process increases markedly resistance of collagenous matrix against digesting enzymes supporting its use in the treatment of corneal ulcers. Since the discovery of this therapeutic procedure and the first laboratory experiments, which confirmed the validity of this method, and the first clinical studies that proved the effectiveness and safety of the technique, it has been spread and adopted worldwide, even with further modifications. Making use of the Bunsen-Roscoe photochemical law it was possible to shorten the duration of this procedure in accelerated CXL and thus improve the clinical workflow and patient compliance while maintaining the efficacy and safety of the procedure. The indication spectrum of CXL can be further expanded by combining it with other vision-enhancing procedures such as individualized topographically-guided excimer ablation. Complementing both techniques will allow a patient with a biomechanically stable cornea to regularize it and improve visual acuity without the need for tissue transplantation, leading to a long-term improvement in quality of life.
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Affiliation(s)
- Frederik Raiskup
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Janine Lenk
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Eberhard Spoerl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Lee SSY, Diaz-Torres S, He W, Yazar S, Chan E, Chong EW, Gharahkhani P, Macgregor S, Lingham G, Mackey DA. Polygenic Prediction of Keratoconus and its Measures: Cross-Sectional and Longitudinal Analyses in Community-Based Young Adults. Am J Ophthalmol 2024; 265:248-256. [PMID: 38740237 DOI: 10.1016/j.ajo.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
AIM This study evaluates the performance of a multitrait polygenic risk score (PRS) in an independent cohort to predict incident or progression of keratoconus. DESIGN Prospective cross-sectional and cohort study METHODS: Setting: Single-center; Study population: 1478 community-based young adults (18-30 years; 51% female), including 609 (52% female) who returned for an 8-year follow-up; Observation procedures: Scheimpflug imaging (Pentacam, Oculus), genotyping and development of a multitrait PRS previously validated to predict keratoconus in older adults.; Main outcome measure: Belin/Ambrόsio enhanced ectasia display (BAD-D) score and keratoconus, defined as BAD-D ≥2.6, were each analyzed against the PRS using linear and logistic regression, respectively. RESULTS Prevalence of keratoconus was 2.5% (95% confidence interval [CI] = 1.9-3.6) in the cross-sectional cohort. Each z-score increase in PRS was associated with worse BAD-D z-score by 0.13 (95%CI = 0.08-0.18) and 1.6 increased odds of keratoconus. The 8-year keratoconus incidence was 2.6% (95%CI = 1.3-4.0). Participants in the highest PRS decile were more likely to have incident keratoconus compared to the rest of the cohort (odds ratio = 3.85, 95%CI = 1.21-12.22). For each z-score increase in PRS, 8-year change in BAD-D z-score worsened by 0.11 (95%CI = 0.04-0.17). CONCLUSIONS A PRS for keratoconus could be useful in predicting incident keratoconus and progression, demonstrating its potential utility in clinical settings to identify patients at high risk of postsurgery ectasia or those who may benefit most from keratoconus intervention.
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Affiliation(s)
- Samantha Sze-Yee Lee
- From the University of Western Australia (S.S.Y.L., S.Y., G.L., D.A.M.), Centre for Ophthalmology and Visual Science (Incorporating the Lions Eye Institute), Perth, WA, Australia.
| | - Santiago Diaz-Torres
- QIMR Berghofer Medical Research Institute (S.D.T., W.H., P.G., S.M.), Brisbane, QLD, Australia; Faculty of Medicine (S.D.T., W.H., P.G., S.M.), University of Queensland, Brisbane, QLD, Australia
| | - Weixiong He
- QIMR Berghofer Medical Research Institute (S.D.T., W.H., P.G., S.M.), Brisbane, QLD, Australia; Faculty of Medicine (S.D.T., W.H., P.G., S.M.), University of Queensland, Brisbane, QLD, Australia
| | - Seyhan Yazar
- From the University of Western Australia (S.S.Y.L., S.Y., G.L., D.A.M.), Centre for Ophthalmology and Visual Science (Incorporating the Lions Eye Institute), Perth, WA, Australia; Single Cell and Computational Genomics Laboratory (S.Y.), Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Elsie Chan
- Centre for Eye Research Australia (E.C., E.W.C., D.A.M.), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Elaine W Chong
- Centre for Eye Research Australia (E.C., E.W.C., D.A.M.), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; Royal Melbourne Hospital (E.W.C.), Melbourne, VIC, Australia
| | - Puya Gharahkhani
- QIMR Berghofer Medical Research Institute (S.D.T., W.H., P.G., S.M.), Brisbane, QLD, Australia; Faculty of Medicine (S.D.T., W.H., P.G., S.M.), University of Queensland, Brisbane, QLD, Australia; School of Biomedical Sciences (P.G.), Queensland University of Technology, Brisbane, QLD, Australia
| | - Stuart Macgregor
- QIMR Berghofer Medical Research Institute (S.D.T., W.H., P.G., S.M.), Brisbane, QLD, Australia; Faculty of Medicine (S.D.T., W.H., P.G., S.M.), University of Queensland, Brisbane, QLD, Australia
| | - Gareth Lingham
- From the University of Western Australia (S.S.Y.L., S.Y., G.L., D.A.M.), Centre for Ophthalmology and Visual Science (Incorporating the Lions Eye Institute), Perth, WA, Australia; Centre for Eye Research Ireland (G.L.), Environmental, Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - David A Mackey
- From the University of Western Australia (S.S.Y.L., S.Y., G.L., D.A.M.), Centre for Ophthalmology and Visual Science (Incorporating the Lions Eye Institute), Perth, WA, Australia; Centre for Eye Research Australia (E.C., E.W.C., D.A.M.), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; School of Medicine, Menzies Research Institute Tasmania (D.A.M.), University of Tasmania, Hobart, TAS, Australia
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Meyer JJ, Meeks H, Li K, Guinto E, Olson RJ. Mortality and Causes of Death Among Individuals With Keratoconus. Cornea 2024:00003226-990000000-00542. [PMID: 38692671 DOI: 10.1097/ico.0000000000003548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The purpose of this study was to determine whether there is an increased risk of mortality among individuals with keratoconus. METHODS This was a retrospective, case-control study using the Utah Population Database. Cases were defined as individuals diagnosed with keratoconus from 1996 to 2020 and were matched 5:1 with controls on birth year, sex, whether born in Utah, and follow-up time in Utah. Individuals diagnosed with trisomy 21 or connective tissue disease were excluded. Main outcome measures were the all-cause and cause-specific mortality among keratoconus cases compared with matched controls. Cox regression models were used, additionally adjusting for race and ethnicity. RESULTS A total of 7847 keratoconus cases and 38,597 controls were studied in the final analyses. The mean age at index diagnosis was 43 ± 17 years, and mean age at last follow-up was 54 ± 17 years for both cases and controls. At last follow-up, 92% of cases were living compared with 91% of controls. After adjusting for covariates, there were no significant differences in all-cause mortality (P = 0.161), mortality from natural causes (0.222), or mortality from unnatural causes (P = 0.494) between cases and controls. When analyzed according to specific causes of death, keratoconus cases had a higher mortality risk from diseases of the nervous system and sense organs compared with their matching controls (hazard ratio 1.59; 95% confidence interval, 1.19-2.11; P = 0.002). CONCLUSIONS There was no evidence of an increased risk of mortality among individuals with keratoconus. There may be an increased risk of death due to diseases of the nervous system and sense organs among individuals with keratoconus.
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Affiliation(s)
- Jay J Meyer
- Department of Ophthalmology, University of Utah, Salt Lake City, UT
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Huong Meeks
- Department of Pediatrics, University of Utah, Salt Lake City, UT; and
| | - Kuan Li
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Emily Guinto
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Randall J Olson
- Department of Ophthalmology, University of Utah, Salt Lake City, UT
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Zhu X, Cheng D, Ruan K, Shen M, Ye Y. Causal relationships between type 2 diabetes, glycemic traits and keratoconus. Front Med (Lausanne) 2023; 10:1264061. [PMID: 38020157 PMCID: PMC10658005 DOI: 10.3389/fmed.2023.1264061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The relationship between diabetes mellitus and keratoconus remains controversial. This study aimed to assess the potential causal relationships among type 2 diabetes, glycemic traits, and the risk of keratoconus. Methods We used a two-sample Mendelian randomization (MR) design based on genome-wide association summary statistics. Fasting glucose, proinsulin levels, adiponectin, hemoglobin A1c (HbA1c) and type 2 diabetes with and without body mass index (BMI) adjustment were used as exposures and keratoconus was used as the outcome. MR analysis was performed using the inverse-variance weighted method, MR-Egger regression method, weighted-mode method, weighted median method and the MR-pleiotropy residual sum and outlier test (PRESSO). Results Results showed that genetically predicted lower fasting glucose were significantly associated with a higher risk of keratoconus [IVW: odds ratio (OR) = 0.382; 95% confidence interval (CI) = 0.261-0.560; p = 8.162 × 10-7]. Genetically predicted lower proinsulin levels were potentially linked to a higher risk of keratoconus (IVW: OR = 0.739; 95% CI = 0.568-0.963; p = 0.025). In addition, genetically predicted type 2 diabetes negatively correlated with keratoconus (IVW: BMI-unadjusted: OR = 0.869; 95% CI = 0.775-0.974, p = 0.016; BMI-adjusted: OR = 0.880, 95% CI = 0.789-0.982, p = 0.022). These associations were further corroborated by the evidence from all sensitivity analyses. Conclusion These findings provide genetic evidence that higher fasting glucose levels are associated with a lower risk of keratoconus. However, further studies are required to confirmed this hypothesis and to understand the mechanisms underlying this putative causative relationship.
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Affiliation(s)
| | | | | | | | - Yufeng Ye
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Alfardan F, Alsanad MH, Altoub HA. Prevalence of Psychiatric Illness Among Keratoconus Patients. Cureus 2023; 15:e42141. [PMID: 37602110 PMCID: PMC10438187 DOI: 10.7759/cureus.42141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Keratoconus is a chronic corneal disorder characterized by progressive thinning of the cornea resulting in visual deterioration. Keratoconus patients have a higher rate of psychiatric morbidities. Therefore, this study will assess the prevalence of psychiatric illness among keratoconus patients. Methods We conducted a quantitative retrospective study in three centers across Saudi Arabia from June 2016 to February 2023. We included all patients previously diagnosed with keratoconus and any psychiatric illness. We excluded patients with other ocular diseases in addition to keratoconus. After we extracted the data, we coded and analyzed them using IBM SPSS Statistics for Windows, Version 21.0 (2012; IBM Corp., Armonk, New York, United States) and GraphPad Prism Version 8.4.2 (Dotmatics, Boston, Massachusetts, United States). Results The study included 57 keratoconus patients, with the majority being Saudi (96.5%), female (2:1), in the age group of 31-40 years (40.4%), and with a high-school level of education. The majority of patients were also obese (42.4%) and non-smokers (82%). Most patients had comorbid medical disorders. Of the 57 patients, 63.2% had anxiety disorders, 56.1% had depression, 10.5% had schizophrenia, and 1.8% had bipolar disorder. Patients with only a primary-school level of education were significantly more likely to be diagnosed with bipolar disorder, whereas those who were single were significantly more likely to be diagnosed with schizophrenia. Corneal transplant was also significantly associated with schizophrenia. Most patients (51%) were diagnosed with a psychiatric illness before keratoconus was diagnosed. Conclusion Among the keratoconus patients, single relationship status, primary-school level of education, and comorbidities were significantly associated with schizophrenia, bipolar disorder, and anxiety disorder, respectively. In addition, corneal transplant was significantly associated with schizophrenia. Lastly, the occurrence of psychiatric illness before keratoconus diagnosis was observed in the majority of patients.
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Affiliation(s)
- Fahad Alfardan
- Department of Surgery, Division of Ophthalmology, National Guard Hospital, Riyadh, SAU
| | - Meznah H Alsanad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haifa A Altoub
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Unni P, Lee HJ. Systemic Associations with Keratoconus. Life (Basel) 2023; 13:1363. [PMID: 37374145 DOI: 10.3390/life13061363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
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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Affiliation(s)
- Prasida Unni
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Hyunjoo Jean Lee
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
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Gustafsson I, Vicente A, Bergström A, Stenevi U, Ivarsen A, Hjortdal JØ. Current clinical practice in corneal crosslinking for treatment of progressive keratoconus in four Nordic countries. Acta Ophthalmol 2023; 101:109-116. [PMID: 35811357 PMCID: PMC10084360 DOI: 10.1111/aos.15213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/24/2022] [Accepted: 06/26/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate clinical practice in the diagnosis and treatment of progressive keratoconus with corneal crosslinking (CXL) in four Nordic countries. METHODS A questionnaire was sent to all centres at which keratoconus patients are evaluated and CXL is performed in Sweden, Denmark, Norway and Iceland. Nineteen of 20 centres participated. RESULTS CXL is performed approximately 1300 times per year in these four Nordic countries with a population of around 21.7 million (2019). In most cases, progression is evaluated using the Pentacam HR, and the maximum keratometry reading (Kmax ) is considered the most important parameter. The most frequently used treatment protocol in Scandinavia is the 9 mW/cm2 epi-off protocol, using hydroxylpropyl methylcellulose riboflavin (HPMC-riboflavin). The participants deemed the following areas to be in most need of improvement: adaptation of the CXL protocol to individual patients (5/19), the development of effective epi-on treatment protocols (4/19), optimal performance of CXL in thin corneas (4/19), improvement of the definition of progression (2/19), and diagnosis of the need for re-treatment (2/19). CONCLUSIONS We concluded that the diagnosis of progressive keratoconus and the diagnostic equipment used are similar. Treatment strategies are also similar but are suitably different to provide an interesting basis for the comparison of treatment outcomes. The high degree of participation in this survey indicates the possibility of future scientific collaboration on CXL focusing on the areas deemed to need improvement. It would also be of interest to evaluate the possibility of creating a Nordic CXL Registry. The high number of CXL treatments performed ensures sufficient statistical power to solve many questions. Such a registry could be an important contribution to evidence-based care and would allow for longitudinal evaluation.
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Affiliation(s)
- Ingemar Gustafsson
- Department of Clinical Sciences, Department of Ophthalmology, Lund University, Skåne University Hospital, Lund, Sweden
| | - André Vicente
- Department of Clinical Sciences, Department of Ophthalmology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Bergström
- Department of Clinical Sciences, Department of Ophthalmology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ulf Stenevi
- Department of Ophthalmology, Sahgrenska University Hospital, Mölndal, Sweden
| | - Anders Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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Ahmad TR, Kong AW, Turner ML, Barnett J, Kaur G, O’Brien KS, Pasricha ND, Indaram M. Socioeconomic Correlates of Keratoconus Severity and Progression. Cornea 2023; 42:60-65. [PMID: 35184126 PMCID: PMC10738272 DOI: 10.1097/ico.0000000000002993] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the social determinants of health for keratoconus. METHODS In this retrospective cohort study of patients with keratoconus, the electronic health record was reviewed for keratometry, treatments received, clinical comorbidities, and social characteristics. Outcomes included severe keratoconus at presentation (steep keratometry ≥52 diopters), disease progression (≥0.75 diopters increase from the first to the most recent clinical visit), and corneal transplantation. Logistic regression was used to evaluate factors associated with severity at presentation and corneal transplantation. Cox proportional hazards modeling was used to evaluate progression. RESULTS A total of 1038 patients with keratoconus were identified, 725 (70%) of whom had baseline imaging. Compared with commercially insured patients, Medicaid recipients were more likely to have severe keratoconus, independent of social and clinical confounders [odds ratio (OR) 1.94, 95% confidence interval (CI), 1.12-3.35, P = 0.017]. Male sex was independently associated with progression (hazard ratio = 1.38, 95% CI, 1.03-1.84, P = 0.030). Medicare and Medicaid recipients were more likely to require transplantation compared with commercially insured patients (OR 2.71, 95% CI, 1.65-4.46, P < 0.001 and OR 1.74, 95% CI, 1.08-2.80, P = 0.022, respectively). Other social determinants of health, including non-White race/ethnicity, limited English proficiency, and unemployment, were associated with the outcomes only in univariate analysis. Obstructive sleep apnea, atopy, body mass index, and tobacco use were not associated with any outcome. CONCLUSIONS Socioeconomic factors were more consistent predictors of keratoconus severity and corneal transplantation compared with clinical factors that have received relatively greater attention in the keratoconus literature.
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Affiliation(s)
- Tessnim R. Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Alan W. Kong
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Marcus L. Turner
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Jackson Barnett
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Gurbani Kaur
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Kieran S. O’Brien
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA
| | - Neel D. Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
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Song M, Fang QY, Seth I, Baird PN, Daniell MD, Sahebjada S. Non-genetic risk factors for keratoconus. Clin Exp Optom 2022; 106:362-372. [PMID: 35504720 DOI: 10.1080/08164622.2022.2062222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Keratoconus is a complex and multifactorial disease and its exact aetiology remains unknown. This current study examined the important environmental risk factors and their association with keratoconus. This study was registered in the PROSPERO International Prospective Register of systematic reviews under registration number CRD42021256792 in 2021. Scopus, Web of Science, PubMed, and Cochrane CENTRAL databases were searched for all relevant articles published from 1 January 1900 to 31 July 2021. National Institutes of Health Quality Assessment Tool was used to assess the methodological quality of the studies. The assessment for statistical heterogeneity was assessed using the Z-statistics on RevMan v5.4. P-value of <0.05 was considered as statistically significant and I2 < 25% as homogenous. Thirty studies were included in this meta-analysis. Pooled odds ratio was calculated with 95% CI. The pooled odds ratio (OR) of eye rubbing, atopy, asthma, and eczema was 3.64 (95% CI, 2.02, 6.57), 1.90 (95% CI, 1.22, 2.94), 1.36 (95% CI, 1.15, 1.61) and 1.90 (95% CI, 1.22, 2.94), respectively. The OR for diabetes was 0.86 (95% CI 0.73, 1.02), and use of sunglasses, contact lens, allergic conjunctivitis, side sleep position and prone sleep position was 0.40 (95% CI, 0.16, 0.99), 1.68 (0.70, 4.00), 2.24 (95% CI, 0.68, 7.36), 3.81 (95% CI, 0.31, 46.23), 12.76 (95% CI, 0.27, 598.58), respectively. Twenty studies were considered to be of high quality, nine to be moderate and one to be low. Environmental risk factors have been identified to play a role in the susceptibility of keratoconus. However, further large-scale longitudinal studies are needed to understand the mechanisms between environmental risk factors and keratoconus.
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Affiliation(s)
- Minji Song
- Centre for Eye Research Australia, Melbourne, Australia
| | - Qing Yi Fang
- Centre for Eye Research Australia, Melbourne, Australia
| | - Ishith Seth
- Centre for Eye Research Australia, Melbourne, Australia
| | - Paul N Baird
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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He W, Han X, Ong JS, Hewitt AW, Mackey DA, Gharahkhani P, MacGregor S. Association of Novel Loci With Keratoconus Susceptibility in a Multitrait Genome-Wide Association Study of the UK Biobank Database and Canadian Longitudinal Study on Aging. JAMA Ophthalmol 2022; 140:568-576. [PMID: 35446358 PMCID: PMC9026225 DOI: 10.1001/jamaophthalmol.2022.0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Keratoconus can be a debilitating corneal ectasia in which the cornea thins, bulges, and steepens into a conical shape. Early features of keratoconus include myopia and irregular astigmatism, which affect vision and can be treated with contact lenses, collagen cross-linking, or, in advanced cases, corneal transplant. Recent estimates of the prevalence of keratoconus based on results of Scheimpflug imaging in young adults are as high as 1.2%. However, obtaining very large keratoconus data sets for a genome-wide association study (GWAS) is problematic because few population studies include Scheimpflug imaging and because severe keratoconus is relatively rare. Objective To identify novel keratoconus loci using corneal resistance factor (CRF) and central corneal thickness (CCT). Design, Setting, and Participants This multitrait GWAS used European ancestry CRF data from UK Biobank (UKB) (n = 105 427) and the Canadian Longitudinal Study on Aging (CLSA) (n = 18 307) and European ancestry CCT data from the International Glaucoma Genetics Consortium (IGGC) (n = 17 803). The CRF and CCT variants in published keratoconus data sets (4669 cases and 116 547 controls) were compared. The data set from UKB was compiled March 24, 2020; data were released from the CLSA in July 2020; and IGGC data were available from May 1, 2018. Main Outcomes and Measures Association of CRF and CCT variants with keratoconus risk. Results The GWAS included 4 cohorts: 105 427 UKB European ancestry (56 134 women [53.2%] and 49 293 men [46.7%]; mean [SD] age, 57 [8] years), 5029 UKB South Asian ancestry (2368 women [47.1%] and 2661 men [52.9%]; mean [SD] age, 54 [8] years), 902 UKB East Asian ancestry (622 women [68.9%] and 280 men [31.0%]; mean [SD] age, 53 [8] years), and 18 307 CLSA European ancestry (9260 women [50.6%] and 9047 men [49.4%]; mean [SD] age, 63 [10] years) participants. A total of 369 CRF and 233 CCT loci were identified, including 36 novel CRF loci and 114 novel CCT loci. Twenty-nine CRF loci and 24 CCT loci were associated with keratoconus. Polygenic risk scores (PRS) were constructed using CRF- and CCT-associated variants and published keratoconus variants. The PRS result showed that adding a CRF- or CCT-based PRS to the keratoconus PRS from previously published variants improved the prediction area under the receiver operating characteristic curve (from 0.705 to 0.756 for CRF and from 0.715 to 0.755 for CCT). Conclusions and Relevance These findings support the use of multitrait modeling of corneal parameters in a relatively large data set to identify new keratoconus risk loci and enhance polygenic risk score models.
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Affiliation(s)
- Weixiong He
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Xikun Han
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Jue-Sheng Ong
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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11
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Lee SSY, Nilagiri VK, Mackey DA. Sleep and eye disease: A review. Clin Exp Ophthalmol 2022; 50:334-344. [PMID: 35263016 PMCID: PMC9544516 DOI: 10.1111/ceo.14071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022]
Abstract
There is a growing body of literature on the effects of sleep disorders, in particular obstructive sleep apnoea (OSA), on ocular health, with consistent evidence of an increased risk of floppy eyelid syndrome, non-arteritic anterior ischaemic optic neuropathy, diabetic macular oedema, and other retinal vasculature changes in individuals with OSA. However, reports on OSA's associations with glaucoma, papilloedema, diabetic retinopathy, central serous chorioretinopathy, and keratoconus have been conflicting, while links between OSA and age-related macular degeneration have only been described fairly recently. Despite numerous suggestions that OSA treatment may reduce risk of these eye diseases, well-designed studies to support these claims are lacking. In particular, the ocular hypertensive effects of continuous positive airway pressure (CPAP) therapy for OSA requires further investigation into its potential impact on glaucoma risk and management. Reports of ocular surface complications secondary to leaking CPAP masks highlights the importance of ensuring good mask fit. Poor sleep habits have also been linked with increased myopia risk; however, the evidence on this association remains weak.
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Affiliation(s)
- Samantha S Y Lee
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - Vinay K Nilagiri
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating the Lions Eye Institute), University of Western Australia, Perth, Western Australia, Australia.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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12
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Toprak I, Cetin EN, Akbulut S, Pekel G, Yuksel S, Cobankara V. Enhanced Ectasia Screening in Patients with Uveitis and Isolated Systemic Inflammatory Disease. Ocul Immunol Inflamm 2022; 30:324-329. [PMID: 33026932 DOI: 10.1080/09273948.2020.1817498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate corneal topographic alterations in patients with uveitis and isolated systemic inflammatory disease (SID). METHODS This retrospective cross-sectional study included 44 patients with uveitis with anterior chamber inflammation (uveitis group), 39 subjects with isolated SID, and 91 healthy controls (control group). Topographic images were classified as "normal," "keratoconus (KC) suspect" and "KC" based on maps of axial curvature, corneal thickness, front and back elevation in combination with Belin/Ambrósio Enhanced Ectasia Display (BAD). RESULTS The uveitis and SID groups had higher incidence of KC (6.8% and 10.2%, respectively) and KC suspect (45.5% and 33.3%, respectively), whereas 2.2% of the control subjects had KC and 26.4% represented KC suspect (p < .05). CONCLUSIONS Patients with uveitis with or without SID, and isolated SID without intraocular inflammation seem to be more likely to have KC and KC suspect, which might be due to systemic and/or local inflammatory background triggering pathophysiological mechanisms underlying KC.
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Affiliation(s)
- Ibrahim Toprak
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ebru Nevin Cetin
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Selen Akbulut
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gokhan Pekel
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Selcuk Yuksel
- Department of Pediatric Rheumatology and Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Veli Cobankara
- Department of Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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13
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Yang K, Gu Y, Xu L, Fan Q, Zhu M, Wang Q, Yin S, Zhang B, Pang C, Ren S. Distribution of pediatric keratoconus by different age and gender groups. Front Pediatr 2022; 10:937246. [PMID: 35923788 PMCID: PMC9339668 DOI: 10.3389/fped.2022.937246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the distribution of pediatric keratoconus patients and the disease severity based on different age and gender groups in China. MATERIALS AND METHODS A total of 446 keratoconus eyes in 266 pediatric patients from January 2019 to January 2022 were included in the cross-sectional study. The clinical findings and severity of keratoconus were recorded and Kruskal-Wallis test, chi-squared test, and Cochran-Mantel-Haenszel (CMH) test were used to compare the parameters between different gender and age groups. RESULTS The male/female ratio was 353/93 (3.8:1), and the median age was 16 years (range: 6-17 years). Male patients were statistically younger than female patients (P = 0.041). The male/female ratio decreased with age (P for trend = 0.011). The distribution of the topographic keratoconus classification (TKC) stage was significantly different between gender and age groups (all P < 0.05). Male patients had a higher ratio of advanced keratoconus eyes (TKC ≥ 3) than female patients (P < 0.001), and CMH analysis indicated that being a male was a risk factor for advanced keratoconus after controlling for age (odds ratio: 2.581, P < 0.001). CONCLUSION Male keratoconus patients were younger, with a higher ratio of advanced keratoconus than female patients in the Chinese pediatric patients evaluated. Multicenter studies with larger sample sizes are necessary in the future.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Meng Zhu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Qing Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Shanshan Yin
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
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14
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Ates KM, Estes AJ, Liu Y. Potential underlying genetic associations between keratoconus and diabetes mellitus. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100005. [PMID: 34746916 PMCID: PMC8570550 DOI: 10.1016/j.aopr.2021.100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 12/14/2022]
Abstract
Background Keratoconus (KC) is the most common ectatic corneal disease, characterized by significantly localized thinning of the corneal stroma. Genetic, environmental, hormonal, and metabolic factors contribute to the pathogenesis of KC. Additionally, multiple comorbidities, such as diabetes mellitus, may affect the risk of KC. Main Body Patients with diabetes mellitus (DM) have been reported to have lower risk of developing KC by way of increased endogenous collagen crosslinking in response to chronic hyperglycemia. However, this remains a debated topic as other studies have suggested either a positive association or no association between DM and KC. To gain further insight into the underlying genetic components of these two diseases, we reviewed candidate genes associated with KC and central corneal thickness in the literature. We then explored how these genes may be regulated similarly or differentially under hyperglycemic conditions and the role they play in the systemic complications associated with DM. Conclusion Our comprehensive review of potential genetic factors underlying KC and DM provides a direction for future studies to further determine the genetic etiology of KC and how it is influenced by systemic diseases such as diabetes.
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Affiliation(s)
- Kristin M. Ates
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Amy J. Estes
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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15
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Navel V, Malecaze J, Pereira B, Baker JS, Malecaze F, Sapin V, Chiambaretta F, Dutheil F. Oxidative and antioxidative stress markers in keratoconus: a systematic review and meta-analysis. Acta Ophthalmol 2021; 99:e777-e794. [PMID: 33354927 DOI: 10.1111/aos.14714] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the levels of oxidative stress markers and antioxidants in keratoconus compared to healthy subject. METHOD The PubMed, Cochrane Library, Embase, Science Direct and Google Scholar databases were searched on 1st June 2020 for studies reporting oxidative and antioxidative stress markers in keratoconus and healthy controls. Main meta-analysis was stratified by type of biomarkers, type of samples (tears, cornea, aqueous humour and blood) and type of corneal samples (stromal cells, epithelium and endothelium). RESULTS We included 36 articles, for a total of 1328 keratoconus patients and 1208 healthy controls. There is an overall increase in oxidative stress markers in keratoconus compared with healthy controls (standard mean deviation (SMD) = 0.94, 95% confidence interval (95% CI) 0.55-1.33), with a significant increase in reactive oxygen and nitrogen species (1.09, 0.41-1.78) and malondialdehyde (1.78, 0.83-2.73). There is an overall decrease in antioxidants in keratoconus compared with healthy controls (-0.63, -0.89 to -0.36), with a significant decrease in total antioxidant capacity/status (-1.65, -2.88 to -0.43), aldehyde/NADPH dehydrogenase (-0.77, -1.38 to -0.17), lactoferrin/transferrin/albumin (-1.92, -2.96 to -0.89) and selenium/zinc (-1.42, -2.23 to -0.61). Oxidative stress markers were higher in tears and in cornea of keratoconus than in aqueous humour, and antioxidants were decreased in tears, aqueous humour and blood without difference between sample type. Oxidative stress markers increased in stromal cells and antioxidants decreased in endothelium. CONCLUSION Oxidative stress markers and antioxidants were dysregulated in keratoconus, involving an imbalance of redox homeostasis in tears, cornea, aqueous humour and blood.
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Affiliation(s)
- Valentin Navel
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Jean Malecaze
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Bruno Pereira
- Clinical Research and Innovation Direction CHU Clermont–Ferrand University Hospital of Clermont Ferrand Clermont‐Ferrand France
| | - Julien S. Baker
- Department of Sport, Physical Education and Health Centre for Health and Exercise Science Research Hong Kong Baptist University Kowloon Tong Hong Kong
| | - François Malecaze
- Ophthalmology Department Pierre‐Paul Riquet Hospital University Hospital of Toulouse Toulouse France
| | - Vincent Sapin
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
- Medical Biochemistry and Molecular Biology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| | - Frédéric Chiambaretta
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Frédéric Dutheil
- Preventive and Occupational Medicine CNRS, LaPSCo Physiological and Psychosocial Stress CHU Clermont‐Ferrand Université Clermont Auvergne University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
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16
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Munir SZ, Munir WM, Albrecht J. Estimated Prevalence of Keratoconus in the United States From a Large Vision Insurance Database. Eye Contact Lens 2021; 47:505-510. [PMID: 34224446 DOI: 10.1097/icl.0000000000000812] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To estimate the prevalence of keratoconus in the United States using a large vision insurance database. METHODS We used data from the 2016 vision service plan (VSP) Global claims database to estimate the prevalence of keratoconus among enrollees by state. The VSP Global database includes cross-sectional de-identified claims data summarized by state of residence in predefined age and gender groups. Crude values of prevalence of keratoconus are provided in the VSP Global database. The open-source software package qGIS version 3.12 was used as the geographic information system for geospatial analysis. RESULTS The prevalence of keratoconus among VSP enrollees in the United States was estimated to be 0.15% with 95% confidence interval (CI) (0.15%, 0.15%). The prevalence of keratoconus was highest in Western states and among male population. The highest prevalence of keratoconus was in Colorado (0.51%; 95% CI 0.49%-0.52%), with particularly high prevalence for men in the age groups 18 to 39 years (0.90%; 95% CI 0.84%-0.95%) and 40 to 64 years (0.90%; 95% CI 0.85%-0.95%). CONCLUSION The average prevalence of keratoconus in the United States in 2016 may be higher than previously reported. Living in Western states and male sex were associated with high prevalence.
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Affiliation(s)
- Saleha Z Munir
- Departments of Ophthalmology and Vision Sciences (S.Z.M.), and Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore, MD
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Lin AN, Mohammed ISK, Munir WM, Munir SZ, Alexander JL. Inter-rater Reliability and Repeatability of Manual Anterior Segment Optical Coherence Tomography Image Grading in Keratoconus. Eye Contact Lens 2021; 47:494-499. [PMID: 34294643 PMCID: PMC8384674 DOI: 10.1097/icl.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the repeatability of corneal measurements from anterior segment optical coherence tomography (AS-OCT) images using ImageJ software in healthy eyes compared with eyes with keratoconus. METHODS Anterior segment OCT images of 25 eyes from 14 healthy subjects and 25 eyes from 15 subjects with keratoconus between the ages of 20 and 80 years were evaluated. Two trained observers used ImageJ to measure the central corneal cross-sectional area and anterior and posterior corneal arc lengths. MedCalc statistical software was used to generate the intraclass correlation coefficient (ICC) and Bland-Altman plots (BAPs) for observer measurements. RESULTS Observer measurements of the central corneal cross-sectional area and anterior and posterior corneal arc lengths yielded an ICC >0.7. The ICC comparing the 3 parameters ranged from 0.75 to 0.84 for the control and 0.96 to 0.98 for the keratoconus group. No systematic proportional bias was detected by the BAPs. There were minimal differences between the 2 observer's measurements, with a mean of the difference of 0.3 mm2, 0 mm, and 0 mm, for the 3 measurements, respectively. CONCLUSIONS This study suggests that ImageJ software is a repeatable and reliable tool in the analysis of corneal parameters from AS-OCT images among patients with keratoconus and may be applicable to AS-OCT imaging protocol development, an area of active keratoconus research.
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Affiliation(s)
- Anna N Lin
- University of Maryland School of Medicine (A.N.L.), Baltimore, MD; and Department of Ophthalmology (I.S.K.M., W.M.M., S.Z.M., J.L.A.), University of Maryland Eye Associates, University of Maryland, Baltimore, MD
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18
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Corneal transplantation for keratoconus in South Korea. Sci Rep 2021; 11:12580. [PMID: 34131255 PMCID: PMC8206092 DOI: 10.1038/s41598-021-92133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
This nationwide population-based study investigated the incidence rate of and risk factors for the progression to corneal transplantation in patients with keratoconus in South Korea using claims data from the Health Insurance Review and Assessment service. Among the entire South Korean population, 10,612 patients newly diagnosed with keratoconus between January 2010 and June 2015 were identified and included in the study. During the study period, 124 patients (1.17%) underwent corneal transplantation, with an average follow-up period of 2.97 ± 1.59 years. The incidence rate of corneal transplantation in patients with keratoconus was 4.46 cases per 1000 person-years. The rate of corneal transplantation for keratoconus was relatively low in South Korea compared to other countries. Multivariate Cox regression analysis revealed that male sex (HR 2.37; 95% CI 1.61–3.50; P < 0.001), severe atopic dermatitis (HR 2.32; 95% CI 1.02–5.28; P = 0.044), obstructive sleep apnea (HR 9.78; 95% CI 1.36–70.10; P = 0.023), and intellectual disability (HR 4.48; 95% CI 1.33–15.11; P = 0.016) significantly increased the risk of progression to corneal transplantation. In patients with keratoconus, male sex, severe atopic dermatitis, obstructive sleep apnea, and intellectual disability were associated with an increased risk of corneal transplantation.
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19
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Ahuja P, Dadachanji Z, Shetty R, Nagarajan SA, Khamar P, Sethu S, D'Souza S. Relevance of IgE, allergy and eye rubbing in the pathogenesis and management of Keratoconus. Indian J Ophthalmol 2021; 68:2067-2074. [PMID: 32971611 PMCID: PMC7727983 DOI: 10.4103/ijo.ijo_1191_19] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Keratoconus (KC) is an ectatic disease of the cornea characterized by localized thinning and protrusion causing irregular astigmatism, which can lead to significant visual impairment. KC has often been associated with allergy and/or atopy, which are immune-mediated inflammatory reactions primarily driven by IgE. A higher proportion of KC patients were reported to have history or suffer from systemic and/or ocular allergy with elevated allergen-specific IgE and/or total serum IgE. Eye rubbing, one of the risk factors for worsening of the disease and developing related complications in KC, is associated with IgE driven conditions. The current review enumerates and contextualizes the evidence related to IgE in mediating KC pathogenesis, including aberrant extra-cellular matrix remodeling. This review also discusses clinical strategies directed at modulating IgE-mediated responses in the management of KC, and the emerging academic and plausible clinical relevance of assessing serum and tear IgE (allergen-specific and total) status in improving the understanding of disease pathobiology, treatment planning, and prognosis.
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Affiliation(s)
- Prerna Ahuja
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Zelda Dadachanji
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Sowmya Arudi Nagarajan
- Department of Paediatrics, Allergy and Immunology, Manipal Hospital, Bangalore, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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20
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Yang K, Xu L, Fan Q, Gu Y, Zhang B, Meng F, Zhao D, Pang C, Ren S. A hospital-based study on clinical data, demographic data and visual function of keratoconus patients in Central China. Sci Rep 2021; 11:7559. [PMID: 33824422 PMCID: PMC8024332 DOI: 10.1038/s41598-021-87291-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
China is a populous country but lacks epidemiological data on keratoconus (KC). The present study aimed to investigate the clinical data, demographic data, and visual function (VF) data of KC patients in Central China. A total of 524 KC eyes in 307 KC patients (217 bilateral and 90 unilateral) from Henan Eye Hospital were included in the current study. Demographic and VF data were assessed with questionnaires administered by well-trained staff during face-to-face interviews. Visual acuity value was examined by a qualified optometrist, and the clinical data were measured by professional clinicians. The distributions of sex, residence and education level of KC patients were compared by Chi-square tests, and the ratios of people wearing glasses and rigid gas permeable (RGP) lenses were compared by McNemar tests. General linear models/Chi-squared tests were used to compare the clinical and demographic data according to KC severity. Spearman’s correlation analysis was used to test the associations between the data and KC severity. The mean age at diagnosis was 20.98 ± 6.06 years, and males had a higher ratio of KC than females (P < 0.001). Patients in rural areas had a higher rate of KC than those in urban areas (P = 0.039), and the proportion of KC patients with a higher education level (above high school) was high (P < 0.001). A total of 68.40% of the patients reported eye rubbing and 3.52% had a positive family history. The percentage of people wearing glasses was higher than that of patients wearing RGP lenses (P < 0.001). The total VF score of KC patients was 69.35 ± 15.25. The thinnest corneal thickness (TCT) and stiffness parameter at the first applanation (SP-A1) values were inversely correlated with KC severity (P < 0.05). The mean, steep, and max keratometry (Km, Ks and Kmax) values, the RGP lens use and keratoplasty were positively correlated with KC severity (all P < 0.05). The total VF score of the eye with better VA decreased as the severity increased (r = − 0.21, P = 0.002). The present study comprehensively describes various associated features of KC patients from a tertiary hospital in Central China, providing a reference for understanding the characteristics of KC patients in China.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Feiying Meng
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, People's Republic of China.
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Abstract
Purpose of Review To summarize the recent advances in transcriptomics and proteomics studies of keratoconus using advanced genome-wide gene and protein expression profiling techniques. Recent Findings Second-generation sequencing including RNA sequencing has been widely used to characterize the genome-wide gene expression in corneal tissues or cells affected by keratoconus. Due to different sample types, sequencing platforms, and analysis pipeline, different lists of genes have been identified to be differentially expressed in KC-affected samples. Gene ontology and pathway/network analyses have indicated the involvement of genes related with extracellular matrix, WNT-signaling, TGFβ pathway, and NRF2-regulated network. High throughput proteomics studies using mass spectrometry have uncovered many KC-related protein molecules in pathways related with cytoskeleton, cell matrix, TGFβ signaling, and extracellular matrix remodeling, consistent with gene expression profiling. Summary Both transcriptomics and proteomics studies using genome-wide gene/protein expression profiling techniques have identified significant genes/proteins that may contribute to the pathogenesis of keratoconus. These molecules may be involved in functional categories related with extracellular matrix and TGFβ signaling. It is necessary to perform comprehensive gene/protein expression studies using larger sample size, same type of samples, up-to-date platform and bioinformatics tools.
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22
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Hardcastle AJ, Liskova P, Bykhovskaya Y, McComish BJ, Davidson AE, Inglehearn CF, Li X, Choquet H, Habeeb M, Lucas SEM, Sahebjada S, Pontikos N, Lopez KER, Khawaja AP, Ali M, Dudakova L, Skalicka P, Van Dooren BTH, Geerards AJM, Haudum CW, Faro VL, Tenen A, Simcoe MJ, Patasova K, Yarrand D, Yin J, Siddiqui S, Rice A, Farraj LA, Chen YDI, Rahi JS, Krauss RM, Theusch E, Charlesworth JC, Szczotka-Flynn L, Toomes C, Meester-Smoor MA, Richardson AJ, Mitchell PA, Taylor KD, Melles RB, Aldave AJ, Mills RA, Cao K, Chan E, Daniell MD, Wang JJ, Rotter JI, Hewitt AW, MacGregor S, Klaver CCW, Ramdas WD, Craig JE, Iyengar SK, O'Brart D, Jorgenson E, Baird PN, Rabinowitz YS, Burdon KP, Hammond CJ, Tuft SJ, Hysi PG. A multi-ethnic genome-wide association study implicates collagen matrix integrity and cell differentiation pathways in keratoconus. Commun Biol 2021; 4:266. [PMID: 33649486 PMCID: PMC7921564 DOI: 10.1038/s42003-021-01784-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
Keratoconus is characterised by reduced rigidity of the cornea with distortion and focal thinning that causes blurred vision, however, the pathogenetic mechanisms are unknown. It can lead to severe visual morbidity in children and young adults and is a common indication for corneal transplantation worldwide. Here we report the first large scale genome-wide association study of keratoconus including 4,669 cases and 116,547 controls. We have identified significant association with 36 genomic loci that, for the first time, implicate both dysregulation of corneal collagen matrix integrity and cell differentiation pathways as primary disease-causing mechanisms. The results also suggest pleiotropy, with some disease mechanisms shared with other corneal diseases, such as Fuchs endothelial corneal dystrophy. The common variants associated with keratoconus explain 12.5% of the genetic variance, which shows potential for the future development of a diagnostic test to detect susceptibility to disease.
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Affiliation(s)
- Alison J Hardcastle
- UCL Institute of Ophthalmology, London, UK.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
| | - Petra Liskova
- UCL Institute of Ophthalmology, London, UK
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Yelena Bykhovskaya
- The Cornea Eye Institute, Beverly Hills, CA, USA
- Department of Surgery and Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bennet J McComish
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | - Chris F Inglehearn
- Division of Molecular Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Xiaohui Li
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation (formerly Los Angeles Biomedical Research Institute) at Harbor-UCLA Medical Center; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Hélène Choquet
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mahmoud Habeeb
- Department of Ophthalmology, Erasmus Medical Center GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center GD, Rotterdam, The Netherlands
| | - Sionne E M Lucas
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Srujana Sahebjada
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | | | | | - Anthony P Khawaja
- UCL Institute of Ophthalmology, London, UK
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Manir Ali
- Division of Molecular Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Lubica Dudakova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavlina Skalicka
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Bart T H Van Dooren
- Department of Ophthalmology, Erasmus Medical Center GD, Rotterdam, The Netherlands
- Amphia Hospital, Breda, The Netherlands
| | | | - Christoph W Haudum
- Division of Endocrinology and Diabetology, Endocrinology Lab Platform, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Valeria Lo Faro
- Department of Ophthalmology, University Medical Center Groningen (UMCG), Groningen, the Netherlands
- Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
| | - Abi Tenen
- Vision Eye Institute, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Melbourne Stem Cell Centre, Melbourne, VIC, 3800, Australia
| | - Mark J Simcoe
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Karina Patasova
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Darioush Yarrand
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jie Yin
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Salina Siddiqui
- Division of Molecular Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Ophthalmology, St James's University Hospital, Leeds, UK
| | - Aine Rice
- Division of Molecular Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Layal Abi Farraj
- Division of Molecular Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation (formerly Los Angeles Biomedical Research Institute) at Harbor-UCLA Medical Center; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jugnoo S Rahi
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK
| | | | | | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | - Carmel Toomes
- Division of Molecular Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus Medical Center GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center GD, Rotterdam, The Netherlands
| | - Andrea J Richardson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Paul A Mitchell
- Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation (formerly Los Angeles Biomedical Research Institute) at Harbor-UCLA Medical Center; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ronald B Melles
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Anthony J Aldave
- The Jules Stein Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Richard A Mills
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | - Ke Cao
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Elsie Chan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Mark D Daniell
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Jie Jin Wang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation (formerly Los Angeles Biomedical Research Institute) at Harbor-UCLA Medical Center; Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex W Hewitt
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Vision Eye Institute, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Melbourne Stem Cell Centre, Melbourne, VIC, 3800, Australia
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center GD, Rotterdam, The Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus Medical Center GD, Rotterdam, The Netherlands
| | - Jamie E Craig
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | - Sudha K Iyengar
- Department of Ophthalmology, Case Western Reserve University, Cleveland, OH, USA
| | - David O'Brart
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
- St Thomas Hospital, Guy's and St. Thomas NHS Trust, London, London, UK
| | - Eric Jorgenson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Paul N Baird
- Department of Surgery, Ophthalmology, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Yaron S Rabinowitz
- The Cornea Eye Institute, Beverly Hills, CA, USA
- Department of Surgery and Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Department of Ophthalmology, Flinders University, Adelaide, SA, Australia
| | - Chris J Hammond
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- St Thomas Hospital, Guy's and St. Thomas NHS Trust, London, London, UK
| | - Stephen J Tuft
- UCL Institute of Ophthalmology, London, UK.
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK.
| | - Pirro G Hysi
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK.
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
- UCL Great Ormond Street Hospital Institute of Child Health, London, UK.
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Weng S, Jan R, Wang J, Tseng S, Chang Y. Association between atopic keratoconjunctivitis and the risk of keratoconus. Acta Ophthalmol 2021; 99:e54-e61. [PMID: 32567209 DOI: 10.1111/aos.14509] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To investigate the risk of keratoconus (KCN) in patients with atopic keratoconjunctivitis (AKC). METHODS This nationwide, retrospective, matched cohort study included 186 202 newly diagnosed AKC patients who were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 372.05, and selected from the Taiwan National Health Insurance Research Database. The age- and sex-matched control group included 186 202 non-AKC patients selected from the Taiwan Longitudinal Health Insurance Database 2000. Patient information was collected between 1 January 2004 and 31 December 2011, and both groups of patients were tracked from the index date until December 2013. The incidence and risk of KCN (ICD-9-CM, code 371.6) were compared between the groups. A Cox proportional hazard regression analysis was performed to obtain the adjusted hazard ratio (HR) for KCN. The cumulative KCN incidence rate was calculated with the Kaplan-Meier analysis. RESULTS In total, 62 AKC patients and 26 controls developed KCN during the follow-up period. The incidence rate of KCN was 2.49 times (95% confidence interval [CI] = 1.57-3.93; p < 0.0001) higher in AKC patients than in controls. After adjusting for potential confounders, AKC patients were 2.25 times more likely to develop KCN than controls (adjusted HR, 2.25; 95% CI = 1.41-3.58; p < 0.05). CONCLUSION Atopic keratoconjunctivitis (AKC) patients had an increased risk of developing KCN. Therefore, AKC patients should be advised of this risk.
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Affiliation(s)
- Shih‐Feng Weng
- Department of Healthcare Administration and Medical Informatics College of Health Sciences Kaohsiung Medical University Kaohsiung Taiwan
- Department of Medical Research Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Center for Medical informatics and Statistics Office of R&D Kaohsiung Medical University Kaohsiung Taiwan
| | - Ren‐Long Jan
- Department of Pediatrics Chi Mei Medical Center, Liouying Tainan Taiwan
- Graduate Institute of Medical Science College of Health Science Chang Jung Christian University Tainan Taiwan
| | - Jhi‐Joung Wang
- Department of Medical Research Chi Mei Medical Center Tainan Taiwan
- Department of Anesthesiology Chi Mei Medical Center Tainan Taiwan
- AI Biomed Center Southern Taiwan University of Science and Technology Tainan Taiwan
| | - Sung‐Huei Tseng
- Department of Ophthalmology National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan Taiwan
- Department of Ophthalmology Chi Mei Medical Center Tainan Taiwan
| | - Yuh‐Shin Chang
- Graduate Institute of Medical Science College of Health Science Chang Jung Christian University Tainan Taiwan
- Department of Ophthalmology Chi Mei Medical Center Tainan Taiwan
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24
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Bykhovskaya Y, Rabinowitz YS. Update on the genetics of keratoconus. Exp Eye Res 2020; 202:108398. [PMID: 33316263 DOI: 10.1016/j.exer.2020.108398] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
In the past few years we have seen a great acceleration of discoveries in the field of keratoconus including new treatments, diagnostic tools, genomic and molecular determinants of disease risk. Recent genome-wide association studies (GWAS) of keratoconus cases and population wide studies of variation in central corneal thickness and in corneal biomechanical properties confirmed already identified genes and found many new susceptibility variants and biological pathways. Recent findings in genetic determinants of familial keratoconus revealed functionally important variants and established first mouse model of keratoconus. Latest transcriptomic and expression studies started assessing novel non-coding RNA targets in addition to identifying tissue specific effects of coding genes. First genomic insights into better prediction of treatment outcomes are bringing the advent of genomic medicine into keratoconus clinical practice.
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Affiliation(s)
- Yelena Bykhovskaya
- Cornea Genetic Eye Institute, Department of Surgery and Board of the Governors Regenerative Medicine Institute, Beverly Hills, Cedars-Sinai, Los Angeles, CA, United States.
| | - Yaron S Rabinowitz
- Cornea Genetic Eye Institute, Department of Surgery and Board of the Governors Regenerative Medicine Institute, Beverly Hills, Cedars-Sinai, Los Angeles, CA, United States
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25
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Sahebjada S, Chan E, Xie J, Snibson GR, Daniell M, Baird PN. Risk factors and association with severity of keratoconus: the Australian study of Keratoconus. Int Ophthalmol 2020; 41:891-899. [PMID: 33200389 DOI: 10.1007/s10792-020-01644-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/29/2020] [Indexed: 01/12/2023]
Abstract
SIGNIFICANCE Our results show that asthmatic patients tend to have more severe KC and thus close monitoring for disease progression would be advised, and appropriate treatment strategies may be actioned stabilise the condition that may reduce the need for future corneal transplantation. PURPOSE To explore a wide range of risk factors associated with the severity of keratoconus (KC). METHODS A cross-sectional study of KC patients was undertaken in Melbourne, Australia. A questionnaire addressing age, gender, educational background, ocular and medical history, smoking and alcohol consumption, and physical examination comprising anthropometric measurements was collected; eye examination was undertaken. The associations between a range of risk factors and the severity of KC were determined using univariate and multivariable linear regression analyses. RESULTS A total of 260 KC subjects were included in this study. Mean age of subject was 35.5 (SD = 14.8) years and the majority of the subjects were European 171 (68.2%). Initial univariate regression analysis identified the following risk factors at the p < 0.1 level with KC: higher body mass index, smoking cigarettes, diabetes, rheumatoid arthritis and asthma were associated with increased severity of KC, whereas eczema was associated with less severe KC. Following multivariable regression analysis, only asthma remained as a significant risk factor associated with 2.2 diopters (D) steeper average mean keratometry compared to KC subjects having no asthma [p = 0.03; β = 2.18; 95% confidence intervals: 1.22, 4.14]. CONCLUSION Our study describes the comprehensive assessment of all the known risk factors in a large KC cohort recruited in Australia. Our study has reported asthma as the only risk factor found to be significantly associated with the severity of KC. The results of this study allow us to better understand the aetiology of KC and such knowledge could be useful in instigate systemic management of patients to slow or prevent KC.
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Affiliation(s)
- Srujana Sahebjada
- Centre for Eye Research Australia, Melbourne, VIC, Australia. .,The University of Melbourne, Melbourne, VIC, Australia.
| | - Elsie Chan
- Centre for Eye Research Australia, Melbourne, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Jing Xie
- Centre for Eye Research Australia, Melbourne, VIC, Australia.,Monash University Melbourne, Melbourne, VIC, Australia
| | - Grant R Snibson
- Centre for Eye Research Australia, Melbourne, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Mark Daniell
- Centre for Eye Research Australia, Melbourne, VIC, Australia.,The University of Melbourne, Melbourne, VIC, Australia.,Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Paul N Baird
- The University of Melbourne, Melbourne, VIC, Australia
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26
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Fard AM, Patel SP, Sorkhabi RD, Salekzamani S, Pezzino E, Nader ND. Posterior pole retinal thickness distribution pattern in keratoconus. Int Ophthalmol 2020; 40:2807-2816. [PMID: 32556673 DOI: 10.1007/s10792-020-01464-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the pattern of retinal thickness distribution in patients with keratoconus (KCN) and its correlation with disease severity. METHODS For this cross-sectional cohort study, the study subjects with documented keratoconus and normal eyes were prospectively enrolled. All subjects had anterior segment (Pentacam HR) and posterior segment (Spectralis) imaging. Posterior segment imaging by optical coherence tomography included the posterior pole asymmetry analysis map. Data were analyzed with multiple linear regression models and correlation tests to examine the mean and variance of the measured thickness of the retina and its distribution relative to the presence and severity of KCN. RESULTS A total of 24 subjects with keratoconus (48 eyes) and 14 normal subjects (28 eyes) enrolled in this study. The posterior pole retinal thickness, both superior and inferior hemifields, as well as the overall retinal thickness in KCN patients was greater than the control group. There was a direct correlation between the overall retinal thickness of the posterior pole and the severity of KCN (R2 = 0.422, P < 0.001). However, the variability of the retinal thickness showed no difference between KCN-afflicted and healthy eyes. CONCLUSION Although KCN is a disease of the anterior segment of the eye, we found an orderly increase in posterior pole retinal thickness that is correlated with the severity of disease in KCN eyes compared to control. These findings suggest that the retina may maintain some degree of plasticity to respond to the degraded optical system of the eye.
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Affiliation(s)
- Ali Mahdavi Fard
- Department of Ophthalmology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Sangita P Patel
- Department of Ophthalmology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.,Research and Ophthalmology Services, Veterans Administration of Western New York Healthcare System, Buffalo, NY, USA
| | - Raana Daei Sorkhabi
- Department of Ophthalmology, Tabriz university of Medical Sciences, Tabriz, Iran
| | - Sara Salekzamani
- Department of Ophthalmology, Tabriz university of Medical Sciences, Tabriz, Iran
| | - Elena Pezzino
- Department of Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, UB-Gateway Bldg Suite 550, 77 Goodell Street, Buffalo, NY, 14203, USA
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, UB-Gateway Bldg Suite 550, 77 Goodell Street, Buffalo, NY, 14203, USA.
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27
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Abstract
BACKGROUND Despite the increasing number of studies focused on the association between obstructive sleep apnea (OSA) and keratoconus (KC), to date, no comprehensive meta-analysis or systematic review was published. OBJECTIVE The objective of this study was to evaluate the association between OSA and KC. DATA SOURCES Sources of data were PubMed, Scopus, and Web of Science databases. STUDY ELIGIBILITY CRITERIA The criteria for study eligibility were case-control studies and cohort studies reporting data on the association of OSA with KC with risk ratio, odds ratio, or hazard ratio with 95% confidence intervals or sufficient raw data for calculation. STUDY APPRAISAL AND SYNTHESIS METHODS Meta-analysis was conducted with a random-effects model using odds ratio with 95% confidence interval as the effect size. Heterogeneity was evaluated using the Q and I tests. Sensitivity analysis and assessment of publication bias were performed. RESULTS Five studies (four case-control studies and one cohort study) published between 2012 and 2016 and involving 33,844 subjects (16,922 patients with KC, 16,922 controls) were included in this meta-analysis. A significant association between OSA and KC has been shown (pooled odds ratio, 1.841; 95% confidence interval, 1.163 to 2.914; P = .009). A significant heterogeneity was observed (Q = 15.8, I = 74.6%). There was no evidence of significant publication bias (P = .07). The sensitivity analyses indicated the stability of results. LIMITATIONS Heterogeneity across the studies was observed. Data from four hospital-based case-control studies and one large population-based cohort study were combined. Most of the included studies ascertained OSA by the Berlin Questionnaire, which is a screening tool. CONCLUSIONS This meta-analysis provides significant evidence that OSA is associated with KC. Therefore, a proper screening for OSA is warned for KC patients for the prevention of various cardiovascular comorbidities. Further prospective studies are warranted to explore more in-depth the casual relationship between the two conditions.
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28
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Abstract
Keratoconus, a progressive corneal ectasia, is a complex disease with both genetic and environmental risk factors. The exact etiology is not known and is likely variable between individuals. Conditions such as hay fever and allergy are associated with increased risk, while diabetes may be protective. Behaviors such as eye rubbing are also implicated, but direct causality has not been proven. Genetics plays a major role in risk for some individuals, with many large pedigrees showing autosomal inheritance patterns. Several genes have been implicated using linkage and follow-up sequencing in these families. Genome-wide association studies for keratoconus and for quantitative traits such as central corneal thickness have identified several genetic loci that contribute to a cumulative risk for keratoconus, even in people without a family history of the disease. Identification of risk genes for keratoconus is improving our understanding of the biology of this complex disease.
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Affiliation(s)
- Sionne E M Lucas
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7001, Australia;
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7001, Australia;
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29
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Gustafsson I, Bergström A, Myers AC, Ivarsen A, Hjortdal J. Association between keratoconus disease severity and repeatability in measurements of parameters for the assessment of progressive disease. PLoS One 2020; 15:e0228992. [PMID: 32059036 PMCID: PMC7021304 DOI: 10.1371/journal.pone.0228992] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Progressive keratoconus can lead to severely impaired vision, but there is currently no consensus on the definition of progressive disease. Errors in the measurement of the parameters commonly used to establish progressive disease were evaluated in an attempt to determine the limits at which a true change in the values can be detected. The possible association between measurement error and disease severity was also investigated to evaluate the need for limits based on disease severity. METHODS Sixty-one eyes were studied in 61 patients with keratoconus. Four replicate measurements were made in each patient using a Scheimpflug-based tomographic system (denoted the PC) and an auto-keratometer (denoted the AK). The repeatability coefficient, i.e., the level below which differences between two measurements are found in 95% of paired observations, was calculated. Patients were further divided into three groups based on disease severity (parameter magnitude). RESULTS Increasing magnitude of all the keratometric parameters investigated was significantly associated with increasing measurement errors, and thus worse repeatability. The maximum keratometry value (Kmax) was the least repeatable parameter (1.23 D, 95% CI 1.11-1.35 D) and showed the strongest association between parameter magnitude and measurement error. The repeatability coefficient ranged between 0.32 and 1.62 D, depending on disease severity. The most repeatable parameter was the flattest central keratometry value (K1), measured with the PC (0.51 D, 95% CI 0.46-0.56 D) and the AK (0.54 D, 95% CI 0.48-0.59 D). K1 showed the weakest association between parameter magnitude and measurement error. The repeatability coefficient for K1 ranged between 0.40 and 0.54 D when using the PC, and between 0.34 and 0.70 D when using the AK in the three groups. CONCLUSIONS The association between the magnitude of the keratometric parameters and their measurement errors suggests that limits should be based on disease severity to ensure reliable detection of progressive keratoconus. Further studies are, however, required.
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Affiliation(s)
- Ingemar Gustafsson
- Department of Clinical Sciences Lund, Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
- * E-mail:
| | - Anders Bergström
- Department of Clinical Sciences Lund, Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | | | - Anders Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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30
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Quartilho A, Gore DM, Bunce C, Tuft SJ. Royston-Parmar flexible parametric survival model to predict the probability of keratoconus progression to corneal transplantation. Eye (Lond) 2019; 34:657-662. [PMID: 31462761 DOI: 10.1038/s41433-019-0554-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/11/2019] [Accepted: 07/04/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To assess a Royston-Parmar flexible parametric survival model to generate a personalised risk profile for keratoconus progression. METHODS We re-analysed a historic database of 2723 individuals with keratoconus. A Royston-Parmar survival model was fitted to predict the likelihood of the worse eye progressing to corneal transplantation. We used a backwards selection multivariable fractional polynomial procedure to assist with selection of covariates and identify appropriate transformation(s) to retain in the final model. Time-dependent receiver operating characteristic (ROC) curves from censored survival data using the Kaplan-Meier (KM) method were computed to visually assess how well the model identified eyes likely to progress. RESULTS In all, 5020 eyes from 2581 patients were available for model development. This included 2378 worst affected eyes, and 313 eyes that progressed to transplantation. The best fitting model [df = 1: Bayes information criterion (BIC) = 1573] included three variables, keratometry [hazard ratio (HR) 0.36: 95% confidence limits (CI) 0.32-0.42], age at baseline [HR 0.97: CI 0.95-0.99] and ethnicity [HR 3.92: CI 2.58-5.95]. Specificity at 1 year was 92.8% (CI 90.4-95.2%) with a corresponding sensitivity of 64.6% (CI 58.9-60.0%). These three prognostic factors account for 41.3% (CI 33.6 - 48.2%) of the variation among the survival curves. CONCLUSION Researchers should consider the Royston-Parmar model as an alternative to the Cox model. We illustrate the concepts and our results may lead to better tools that identify individuals at high risk of keratoconus progression.
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Affiliation(s)
- Ana Quartilho
- Research & Development, NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, UK.,Comprehensive Clinical Trials Unit, University College London, 90 High Holborn, London, UK
| | - Daniel M Gore
- External Disease Department, Moorfields Eye Hospital, 162 City Road, London, UK
| | - Catey Bunce
- Research & Development, NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 162 City Road, London, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.,Primary Care & Public Health Sciences, King's College London, Addison House, Guy's Hospital, London, UK
| | - Stephen J Tuft
- External Disease Department, Moorfields Eye Hospital, 162 City Road, London, UK.
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