Systematic Review And Meta-Analysis Of The Prevalence Of Keratoconus In Adults In Saudi Arabia

This study aimed to systematically synthesize and critically appraise studies reporting the prevalence of keratoconus in adults in Saudi Arabia.

We registered a PROSPERO-guided protocol (CRD420251012684) and systematically searched six databases (Embase, MEDLINE, Cochrane CENTRAL, Web of Science, Scopus, and Google Scholar) up to March 17, 2025, to identify observational studies reporting the prevalence of keratoconus in adults in Saudi Arabia. Methodological rigor was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist, focusing on participant selection, outcome measurement, and statistical validity. Outcome measures primarily included keratoconus prevalence, reported as percentages or cases per 100,000 population.

This analysis pooled results from six articles comprising 4570 individuals distributed across Saudi Arabia. The pooled prevalence of keratoconus was 13% (95% CI: 4% to 22%), with a significant heterogeneity across studies. Regarding the gender specific prevalence, the prevalence was 13% in males and 12% in females, with no significant difference was detected between genders according to the subgroup analysis (χ² = 0.01, p = 0.9162). Prevalence of Suspected keratoconus was 17% (95% CI: 9%–26%).

Keratoconus appears to be diagnosed more frequently in Saudi Arabia than in many countries according to clinical studies; however, the prevalence rates calculated from the data are not to be taken as reliable due to the fact that the number of relevant studies is small, the samples examined were from hospitals and there was considerable variation. Population-based studies using standardized diagnostic criteria are needed to better define the true adult burden and guide screening and service planning in Saudi Arabia.