Prevalence of keratoconus in pediatric population higher than previously reported
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Key takeaways:
- The prevalence of classified and suspected keratoconus was 1:223 in a pediatric population.
- Routine screening for keratoconus during pediatric eye examination may prevent decline in visual outcomes.
The prevalence of keratoconus in children appeared higher than previously reported, highlighting the importance of early screening for the condition, according to a study published in Eye & Contact Lens.
“Increasing awareness by eye care practitioners and the overall health care community about KC prevalence is imperative,” Jennifer S. Harthan, OD, FAAO, FSLS, professor at Illinois College of Optometry and chief of the Cornea Center for Clinical Excellence at Illinois Eye Institute, and colleagues wrote. “Early diagnosis, hopefully before significant vision loss, and implementation of treatment can result in prevention of advanced disease states, preservation of vision and the ability to maintain long-term quality of life.”
They continued, “As such, screening for KC and KC suspects should be part of a routine pediatric eye examination, particularly for those patients showing risks factors such as high astigmatism, reduced best-corrected visual acuity, family history of KC or aberrant corneal presentation.”
In a prospective, observational study, researchers analyzed data from 2,007 patients aged 3 to 18 years (mean age, 11.4 years; 56.1% girls; 60.7% Black) who presented for comprehensive eye examinations between 2017 and 2019 at the Princeton Vision Clinic in Chicago.
To determine the prevalence of keratoconus (KC) in this population, the patients underwent Scheimpflug tomography (Pentacam HR, Oculus), which researchers assessed using automated multimetric analysis (Belin/Ambrósio enhanced ectasia display [BAD3], Oculus) to measure BAD3 Final D (Final D) and back elevation at the thinnest point (BETP).
Researchers defined suspect KC as a Final D of at least 2.00 and less than 3.00, along with a BETP of 18 µm or greater for myopia and 28 µm or greater for hyperopia/mixed astigmatism in at least one eye. A Final D of 3.00 or greater plus the same BETP measurements determined confirmed KC.
Overall, six patients were classified as having KC (prevalence, 1:334), and three were classified as KC suspects (prevalence, 1:669), for a total prevalence of 1:223 for KC and KC suspects.
“The outcomes of this study indicate that the prevalence of KC in the pediatric population is significant,” the researchers wrote. “In this U.S.-based pediatric population, the prevalence is higher than previously reported U.S.-based data on KC, highlighting the importance of earlier screening for KC.”
Noting that prior studies evaluated different patient populations and used different criteria for diagnosing KC, the researchers found these studies reported KC prevalence rates that ranged from 1:265 to 1:2,737.
“Practitioners may have concerns about the ability to capture corneal tomography data in the pediatric population; however, this study demonstrated that reliable tomography scans could be acquired on pediatric patients,” the researchers added.
They noted that further large-scale, multicenter studies are needed to understand the prevalence of KC in the general population, as the lack of diversity of the population demographics in this study may prevent generalization to the larger population.
Perspective
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Joselyn Dlouhy, OD, FAAO
These results highlight a higher prevalence of KC in children than previously reported, emphasizing the importance of Scheimpflug screenings for KC at its earliest manifestation. Early identification can contribute to earlier implementation of effective stabilization treatments, preventing advanced cases and visual loss and improving long-term quality of life.
Shortcomings in the study include the lack of diversity in population demographics, including geographic limitations, socioeconomic status and race. This study included 2,007 patients at a single site; therefore, larger scale studies may be needed to conclude the prevalence of KC in the general population. The study also acknowledges the overall difficulty of determining KC prevalence due to the lack of normative corneal tomography data in the pediatric population.
Despite these limitations, this study provides valuable insights to the prevalence of KC in the pediatric population and brings attention to the importance of preforming baseline tomography screenings on high-risk pediatric patients.
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