Multivariate Determinants Of Emotional Compromise And Subjective Functional Quality Of Life In Surgery-Naïve Keratoconus Patients As Measured With A Novel Scale

Keratoconus, a common corneal ectasia, distorts vision, particularly in adolescents and young adults. It adversely affects quality of life, involving emotional and psychiatric issues. Previous studies noted factors like female gender and reduced visual acuity; however, none comprehensively explored multivariate predictors using the Keratoconus End-Points Assessment Questionnaire (KEPAQ), a unique scale evaluating functional and emotional aspects.

This study examines clinical and tomographic variables influencing KEPAQ scores in a Spanish cohort of surgery-naïve keratoconus patients. Filling a gap in research, it aims to uncover key factors affecting quality of life, offering insights into emotional well-being modulation in this population.

Ocular Surface Unit, Hospital Clínico Universitario de Valladolid, Spain.

This retrospective study investigates visual and tomographic factors influencing the quality of life in 140 Keratoconus patients without prior ocular surgery at Hospital Clínico Universitario de Valladolid. Using the KEPAQ scale, a keratoconus-specific questionnaire evaluating Emotional (KEPAQ-E) and Functional (KEPAQ-F) domains, the study employs quantitative data analysis. A multivariate model was built including different variables, such as sex, age, visual acuity, keratometry, astigmatism, and pachymetry. Model evaluation encompasses F tests, R2 values, and checks for normality and homoscedasticity. The idea is to create a comprehensive model which can explain the values of quality of life in keratoconus patients.

A total of 140 surgery-naïve keratoconus patients were included, with a median age of 39.0 years. Male sex was 57.1%. For the KEPAQ-E sub-scale, the multivariate model proved valid (F = 2.79; p = 0.005), with quality of life being negatively modulated by female sex (β = –0.41) and corrected distance visual acuity in the best eye (β = –0.29). Adding the score of the other sub-scale as a potential explanatory variable proved highly efficient (β = 0.60). For the KEPAQ-F sub-scale, the model was also valid (F = 2.37; p = 0.016), with corneal astigmatism in the best eye negatively modulating quality of life (β = –0.30). Adding the score of the other sub-scale as a potential explanatory variable proved highly efficient (β = 0.62).

Evaluating quality of life is crucial for keratoconus patients. After using multivariate models and a standardized keratoconus-specific scale, we found that being female and having reduced corrected distance visual acuity in the best eye link to lower emotional quality of life. Additionally, higher corneal astigmatism in the worst eye associates with diminished functional quality of life. Notably, the strong correlation between a patient's perceived functional limitations and emotional well-being goes way beyond what clinical and tomographic measures can capture. This underscores the substantial emotional impact of the disease, regardless of the patient's current clinical condition.