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Sleep apnea, asthma linked to greater odds of keratoconus diagnosis
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Black and Latino subjects and subjects with sleep apnea or asthma have an increased risk of keratoconus, according to a study.
The retrospective, longitudinal cohort study included 16,053 subjects with keratoconus and a matching control group of 16,053 subjects without keratoconus.
Subjects with one or more ICD-9 codes for eye-related diagnoses, one or more CPT codes for eye-related visits or diagnostic/therapeutic procedures, or any other claim submitted by an ophthalmologist or optometrist were included.
Black subjects had 57% greater odds and Latino subjects had 43% greater odds of having keratoconus compared with white subjects, after adjustment for confounding factors (both P < .001).
Asian subjects had a 39% lower risk of keratoconus compared with white subjects (P < .001).
Level of education and income did not influence odds of being diagnosed with keratoconus. Subjects living in large rural communities had 20% lower odds (P = .007).
Subjects with uncomplicated diabetes had 20% lower odds of having keratoconus (P = .002); subjects with diabetes complicated by end-organ damage had 52% lower odds (P < .001).
Those with sleep apnea (P = .05), asthma (P < .001) and Down syndrome (P < .001) had an increased risk of keratoconus.
No significant association was seen between keratoconus and allergic rhinitis, mitral valve disorder, aortic aneurysm or depression. – by Matt Hasson
Disclosure: The authors report no relevant financial disclosures.
Perspective
Back to TopDavid R. Hardten, MD
This recent article confirms the suspected associations between keratoconus and genetic and environmental factors. Genetics plays a role, as shown by occasional family members who are also affected with keratoconus, as well as the fact that blacks and Hispanics have a higher incidence of keratoconus, but whites and Asians have a lower incidence. We have seen in the past that patients who sleep on their face also have a higher incidence of keratoconus. Sleep apnea is one of the associations with this behavior, especially when associated with floppy lid. A history of sleep apnea should be elicited from the patient with keratoconus because appropriate referral, diagnosis and treatment of sleep apnea can have other beneficial health effects, may reduce the tendency for progression of the disease, and can also improve results if a patient needs corneal transplantation. This is another example of the benefit of an ophthalmologist to the patient’s systemic health.
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Woodward MA, et al. Ophthalmology. 2015;doi:10.1016/j.ophtha.2015.10.035.
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