Socioeconomic and Clinical Factors Associated with Keratoconus Severity and Follow-Up in a Tertiary Referral Cohort

To evaluate the severity of keratoconus (KCN) at presentation in self-identified minority patients, identify risk factors for progression and surgery, and assess loss to follow-up.

Pentacam tomography records (2014-2021) from a single academic center were screened for KCN using BAD-D ≥1.6 and Kmax ≥47D. Manual chart review confirmed diagnosis, determined severity, and assessed progression and surgical intervention within two years. Demographic, socioeconomic, and clinical parameters were recorded. Logistic regression and generalized linear mixed models were used to evaluate associations, with covariates selected from univariate analysis; final models were determined by backward elimination. The primary outcome was KCN severity at presentation; secondary outcomes were progression, surgery within two years, and loss to follow-up.

Of 21,157 charts reviewed, 797 patients had KCN; 479 were male (60.1%) and 458 (57.5%) identified as racial/ethnic minorities. Mean age at presentation was 41.7 ± 16.5 years. Severe disease was present in 635 (81.8%) patients. Patients with connective tissue disease were less likely to present with severe KCN (p = 0.0015). Younger age predicted surgical recommendation within two years (p = 0.008). Patients recommended for surgery were more likely to be younger (p = 0.008) and to speak a primary language other than English (p = 0.006). Two-year loss to follow-up (LTFU) was high (65.1%). Smokers were associated with a greater LTFU (p = 0.0475). However, patients with eczema (p = 0.0388) or those with other ocular diseases (p = 0.0058) were less likely to be LTFU.

Markers of socioeconomic disadvantage cluster with worsened disease burden but only select factors remained independently associated after adjustment.