Date Published:
2024 Feb 02
Abstract:
PURPOSE: Investigate trends in keratoconus (KCN) treatment patterns and diagnosis age between 2015-2020 and evaluate sociodemographic associations with treatment approach. DESIGN: Retrospective cohort study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Patients with a new KCN diagnosis from 2015 to 2020 were identified in the Academy IRIS® Registry (Intelligent Research in Sight). METHODS, INTERVENTION, OR TESTING: Associations between sociodemographic factors and treatment were evaluated using multivariable logistic regression. MAIN OUTCOME MEASURES: Outcomes included percentages and rates of each treatment (either collagen crosslinking [CXL], keratoplasty, or no procedure) from 2015 to 2020, age at diagnosis during this period, and sociodemographic factors associated with treatment type. RESULTS: 66,199 patients with a new diagnosis of KCN were identified. The percentage of patients undergoing CXL increased from 0.05% in 2015 to 29.5% in 2020 (P=0.008). The average age (SD) of KCN patients decreased from 44.1 (± 16.9) years in 2015 to 39.2 (± 16.9) years in 2020 (P<0.001). In multivariable analyses comparing CXL versus no procedure and keratoplasty versus no procedure, patients undergoing CXL tended to be younger with the odds of having CXL decreasing with increasing age; e.g., comparing CXL and no procedure patients, using ages 0-20 years as reference, the odds ratio (OR) (95% CI) decreased from 0.62 (0.57-0.67, P<0.0001) for patients 21-40 years to 0.03 (0.02-0.04, P<0.0001) for patients older than 60. Males were more likely than females to have CXL (OR=1.31, 95% CI 1.23-1.40, P<0.0001) and keratoplasty (OR=1.30, 95% CI 1.19-1.42, P<0.0001). Black patients were less likely than White patients to have CXL (OR=0.70, 95% CI 0.63-0.77, P<0.0001) and more likely to have keratoplasty (OR=2.24, 95% CI 2.01-2.50, P<0.0001). Similarly, Hispanic patients had higher odds of CXL (OR=1.12, 95% CI 1.00-1.24, P<0.05) and keratoplasty (OR=1.29, 95% CI 1.12-1.50, P<0.001) compared to non-Hispanic patients. CXL and keratoplasty also varied by region and insurance status. CONCLUSIONS: A significant increase in use of CXL was noted from 2015 to 2020. Sociodemographic differences in treatment among KCN patients may reflect differences in access, utilization, or care patterns, and future studies should aim to identify strategies to improve access for all patients.
