Vitamin D Supplementation Slows Down Keratoconus Progression: An Observational Prospective Study

Published 2022 - 40th Congress of the ESCRS

Reference: PO299 | Type: Free paper | DOI: 10.82333/j1z9-wm81

Authors: Giulio Ferrari* ¹ , Romina Mayra Lasagni Vitar ² , Philippe Fonteyne ³ , Karl Anders Knutsson ⁴ , Federico Bertuzzi ⁴ , Paolo Rama ⁴

¹Cornea and Ocular Surface Disease Unit,IRCCS San Raffaele Scientific Institute,Milan,Italy;Eye Repair Lab,IRCCS San Raffaele Scientific Institute,Milan,Italy, ²Eye Repair Lab,IRCCS San Raffaele Scientific Institute,Milan,Italy, ³Eye Repair Lab ,IRCCS San Raffaele Scientific Institute,Milan,Italy, ⁴Cornea and Ocular Surface Disease Unit,IRCCS San Raffaele Scientific Institute,Milan,Italy

Purpose

The aim of this study was to evaluate the role of Vitamin D (Vit D) deficiency in the progression of Keratoconus (KC) in adolescent patients.

Setting

This observational prospective study was conducted at the Cornea and Ocular Surface Unit of the San Raffaele Scientific Institute, Milan, Italy. The study was carried out in accordance with guidelines established by the Declaration of Helsinki, and it was approved by the Institutional Review Board/Ethics committee.

Methods

Twenty patients (age range: 16-19 years old) presenting KC and Vit D insufficiency (<30 ng/mL) were included (cohort A). Following standard of care, patients received Vit D as per Italian recommendation guidelines. Patients were followed-up for 12 months. At each visit, Best spectacle corrected visual acuity (BSCVA), maximal keratometry (Kmax), and thinnest corneal thickness (TCT) were measured (MS-39 AS-OCT Topography). Progression was defined as Kmax ≥ 1D. Blood samples were collected at different time points to evaluate Vit D levels and systemic markers of collagen and copper metabolism by ELISA or RT-PCR. KC progression of cohort A was compared with age-matched KC patients (n=20, cohort B), which did not receive Vit D supplementation.

Results

We found that Vit D supplementation arrests KC progression in 60% of patients (72% of eyes) at 1 year. Specifically, BSCVA, Kmax, and TCT values did not change significantly during the observation period. Moreover, progression rates (Kmax, TCT, and BSCVA) were significantly lower when compared with age-matched KC patients that did not receive Vit D supplementation. On the other hand, Vit D levels in the plasma were inversely correlated with systemic biomarkers of collagen degradation. Finally, Vit D supplementation increased cell availability of copper, a cofactor indispensable to lysyl oxidase and superoxide dismutase enzymes, which are involved in collagen synthesis and oxidative stress, respectively.

Conclusions

Our data show that Vit D insufficiency is associated with enhanced systemic collagen degradation and altered copper metabolism in adolescent KC patients. These findings support the hypothesis that KC is a systemic disease and suggest that Vit D supplementation could have a role in preventing KC progression. A randomized clinical trial is underway to confirm the efficacy of this treatment.