Factors Associated With Receipt Of Crosslinking For Keratoconus
Published 2023 - 41st Congress of the ESCRS
Reference: FP18.05 | Type: Free paper | DOI: 10.82333/z05k-1a66
Authors: Hyeck-Soo Son* 1 , Liam Nugent 2 , Jiangxia Wang 3 , Varshini Varadaraj 4 , Kerry Smith 5 , Kraig S. Bower 5 , Glory Mgboji 5 , Uri S. Soiberman 5 , Divya Srikumaran 5
1Ophthalmology,Wilmer Eye Institute,Baltimore,United States;Ophthalmology,University Clinic Heidelberg,Heidelberg,Germany, 2Johns Hopkins School of Medicine,Baltimore,United States, 3Biostatistics,Johns Hopkins University Bloomberg School of Public Health,Baltimore,United States, 4Johns Hopkins Disability Health Research Center,Baltimore,United States, 5Ophthalmology,Wilmer Eye Institute,Baltimore,United States
Purpose
To identify factors associated with receipt of standard fluence epithelium-off crosslinking (CXL) for keratoconus (KCN).
Setting
This retrospective, cross-sectional study reviewed electronic health records of treatment-naïve KCN patients seen at Wilmer Eye Institute between January 2017 and September 2020.
Methods
Tomographic data were derived from Pentacam (Oculus, Wetzlar, Germany) devices. Multivariable population-average model using Generalized Estimating Equations (GEE) adjusting for age, gender, race, national area deprivation index (ADI), vision correction method, and disease severity was used to identify factors associated with receipt of CXL.
Results
From 583 KCN patients, 97 (16.6%) underwent CXL for KCN. Patients who received CXL in at least one eye were significantly younger (mean 24.0±7.8 years) than patients who had never undergone CXL (33.4±9.3 years) (p<0.001). In multivariable analysis, Black patients had 63% lower odds of receiving CXL for KCN (OR: 0.37, 95% CI:0.18-0.79) vs. White patients, and older age was protective against receipt of CXL (OR: 0.89 per 1-year increase, 95% CI:0.86-0.93). Stratified analysis by race demonstrated that Black patients presented with significantly worse vision, higher keratometric indices (K1, K2, and Kmax), and thinner corneal pachymetry at baseline vs. White or Asian patients.
Conclusions
In this clinical cohort of KCN patients from a tertiary referral center, Black patients were less likely to receive CXL presumably due to more advanced disease at presentation. Earlier active population screening may be indicated to identify and treat these patients before they become ineligible for treatment and develop irreversible vision loss. Such strategies may improve health equity in KCN management.