Sociodemographic Risk Factors Impacting Keratoconus Treatment in the United States

To assess sociodemographic disparities present in the treatment of keratoconus based on several factors including race, ethnicity, and sex in the United States.

This was a retrospective cohort study using aggregated patient data collected between January 2000 to December 2025 on the TriNetX platform. Patients with keratoconus were identified and stratified into groups separated by ethnicity, race, and sex. Propensity-score matching was performed using baseline characteristics to ensure comparability. Period prevalence of keratoconus in 2025 and risk and hazard ratios with 95% confidence intervals for patients who received either any type of keratoplasty, penetrating keratoplasty, anterior lamellar keratoplasty, or corneal cross-linking (CXL) between cohorts were calculated.

Period prevalence was found to be 0.108% in 2025. After matching, Black patients were more likely to undergo keratoplasty (RR, 1.685; 95% CI, 1.55-1.832) and less likely to undergo CXL (RR, 0.5; 95% CI, 0.445-0.562) when compared with White patients. Patients of Hispanic ethnicity were more likely to undergo keratoplasty (RR, 1.298; 95% CI, 1.139-1.479, P < 0.0001) and less likely to undergo CXL (RR, 0.666; 95% CI, 0.585-0.759, P < 0.0001). In contrast, Asian patients were less likely to undergo keratoplasty (RR, 0.704; 95% CI, 0.522-0.95, P = 0.0208).

This study sheds further light on disparities that may exist for Black and Hispanic patients regarding keratoconus management in the United States. In particular, discrepancies exist in the utilization of treatment options involving keratoplasty in contrast to less-invasive procedures such as CXL.