Factors Associated With Receipt of Crosslinking for Keratoconus.

Area of Science:

• Ophthalmology
• Corneal Diseases
• Ophthalmic Surgery

Background:

• Keratoconus (KCN) is a progressive corneal ectasia leading to vision loss.
• Standard fluence epithelium-off crosslinking (CXL) is a key treatment to halt KCN progression.
• Disparities in KCN management and treatment access require investigation.

Purpose of the Study:

• To identify demographic and clinical factors associated with receiving standard fluence epithelium-off crosslinking (CXL) for keratoconus (KCN).

Main Methods:

• Retrospective, cross-sectional study of treatment-naive KCN patients.
• Electronic health records and Pentacam tomographic data analyzed from January 2017 to September 2020.
• Multivariable generalized estimating equations used to identify factors associated with CXL receipt.

Main Results:

• 16.6% of 583 KCN patients received CXL.
• Younger patients were more likely to receive CXL (mean age 24.0 vs 33.4 years).
• Black patients had significantly lower odds (OR: 0.37) of receiving CXL compared to White patients, presenting with more advanced disease.

Conclusions:

• Black patients with KCN are less likely to receive CXL, potentially due to later presentation with more severe disease.
• Proactive population screening is recommended to identify KCN patients earlier for timely treatment.
• Strategies to improve health equity in KCN management are crucial to prevent irreversible vision loss.