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Factors Associated with Vision Outcomes in Microbial Keratitis: A Multisite Prospective Cohort Study.

Maria A Woodward¹, Emily L Vogt², Leslie M Niziol²

¹Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.

|February 10, 2025

Summary

Microbial keratitis (MK) patients with poorer initial vision, delayed presentation, and larger infiltrates face worse 90-day vision outcomes. Improving care access and reducing delays are crucial for better vision in MK patients.

Keywords:

Corneal ulcer Microbial keratitis Prognosis Vision impairment Vision outcomes

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Area of Science:

Ophthalmology
Infectious Diseases
Public Health

Background:

Microbial keratitis (MK) is a significant cause of vision loss worldwide.
Understanding factors influencing visual outcomes in MK is critical for effective management.
This study investigates predictors of 90-day vision in a diverse MK patient cohort.

Purpose of the Study:

To identify factors associated with 90-day best-corrected visual acuity (BCVA) in patients with microbial keratitis.
To compare these factors between patients in the United States and India.

Main Methods:

A multicenter prospective cohort study involving 479 patients with MK across the US and India.
Data collected included sociodemographics, clinical measures, and BCVA (logarithm of the minimum angle of resolution units) at baseline and 90 days.
Site-stratified multivariable linear regression models were used to analyze associations with 90-day BCVA.

Main Results:

Average 90-day BCVA was 1.36 logMAR in the US and 0.70 logMAR in India.
In the US, worse 90-day BCVA was linked to worse presenting BCVA, longer presentation delays, no contact lens use, and larger infiltrate size.
In India, worse outcomes were associated with worse presenting BCVA, longer delays, diabetes, hypopyon, no recent ocular trauma, and larger infiltrate size.

Conclusions:

Initial visual acuity, time to presentation, and stromal infiltrate size are key predictors of 90-day vision outcomes in MK.
Specific risk factors varied between the US and India, highlighting the need for tailored interventions.
Implementing systems to reduce care delays and improve access is essential for enhancing vision outcomes in MK patients.