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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Socioeconomic and Demographic Disparities in Keratoconus Treatment
Rohith Erukulla1, Mohammad Soleimani2, Maria Woodward3
1From the Department of Ophthalmology and Visual Sciences (R.E., M.S., C.J., T.M., A.S., E.S., H.Y., M.C., J.D.L.C., S.J., J.S., E.T., M.R., A.D.), Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
Purpose:
To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (corneal cross-linking [CXL] and keratoplasty), as well as comorbidities associated with KCN.
Design:
Retrospective clinical cohort study.
Methods:
A total of 3224 patients from the University of Illinois Hospital & Health Sciences System (UI-Health) database from 2020 to 2024 were examined, including 1612 patients with an International Classification of Diseases, Tenth Revision diagnosis of KCN, and 1612 ophthalmology patients as a control group. Multivariable and univariable logistic regression were performed to evaluate the associations between sociodemographic traits and rates of CXL and keratoplasty. Sociodemographic traits included age, sex, race/ethnicity, insurance status, and neighborhood social vulnerability. Best corrected visual acuity (BCVA) and manifest cylinder were used as indicators of disease impact. Comorbid disease rates were compared to a 1:1 distance-matched control group. Main outcome measures were odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions.
Results:
Female individuals received less keratoplasty than male individuals (odds ratio [OR] = 0.55, P < .001). Black individuals received less CXL than White individuals (OR = 0.68, P < .05), as did individuals with Medicaid (OR = 0.27, P < .0001) or no insurance (OR = 0.41, P < .001) compared to those with commercial insurance. Individuals from socially vulnerable neighborhoods received less CXL (OR = 0.56, P < .01) and keratoplasty (OR = 0.66, P < .05). Black female individuals were the most vulnerable, undergoing fewer procedures than White female (OR = 0.58, P < .01) and Black male (OR = 0.65, P < .05) individuals. Black and Hispanic/Latin-X individuals presented with more severe disease (P < .01, P < .0001). Down syndrome was more common (P < .01), and diabetes was less common (P < .0001), in KCN patients.
Conclusions:
Significant sociodemographic disparities exist in the treatment of KCN. Although further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.
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