Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany.
Cornea. 2024 Feb 1;43(2):214-220. doi: 10.1097/ICO.0000000000003353. Epub 2023 Jul 27.
The aim of this study was to identify factors associated with receipt of standard fluence epithelium-off crosslinking (CXL) for keratoconus (KCN).
This retrospective, cross-sectional study reviewed electronic health records of treatment-naive patients with KCN seen at the Wilmer Eye Institute between January 2017 and September 2020. Tomographic data were derived from Pentacam (Oculus, Wetzlar, Germany) devices. Multivariable population-average model using generalized estimating equations adjusting for age, sex, race, national area deprivation index, vision correction method, and disease severity was used to identify factors associated with receipt of CXL.
From 583 patients with KCN, 97 (16.6%) underwent CXL for KCN. Patients who received CXL in at least 1 eye were significantly younger (mean 24.0 ± 7.8 years) than patients who had never undergone CXL (33.4 ± 9.3 years) ( P < 0.001). In multivariable analysis, Black patients had 63% lower odds of receiving CXL for KCN (OR: 0.37, 95% CI, 0.18-0.79) versus White patients, and older age was protective against receipt of CXL (OR: 0.89 per 1-year increase, 95% CI, 0.86-0.93). Comparison of characteristics by race demonstrated that Black patients presented with significantly worse vision, higher keratometric indices (K1, K2, and Kmax), and thinner corneal pachymetry at baseline versus White or Asian patients.
In this clinical cohort of patients with KCN from a tertiary referral center, Black patients were less likely to receive CXL presumably because of more advanced disease at presentation. Earlier active population screening may be indicated to identify and treat these patients before they become ineligible for treatment and develop irreversible vision loss. Such strategies may improve health equity in KCN management.
本研究旨在确定与圆锥角膜（KCN）标准光密度去上皮交联（CXL）治疗相关的因素。
这是一项回顾性、横断面研究，对 2017 年 1 月至 2020 年 9 月期间在威尔默眼科研究所就诊的未经治疗的 KCN 治疗初治患者的电子健康记录进行了回顾。体层数据来自 Pentacam（Oculus，德国威茨拉尔）设备。使用广义估计方程的多变量人群平均模型，调整年龄、性别、种族、国家地区贫困指数、视力矫正方法和疾病严重程度，以确定与 CXL 治疗相关的因素。
在 583 例 KCN 患者中，97 例（16.6%）因 KCN 接受 CXL 治疗。至少有 1 只眼接受 CXL 治疗的患者明显比从未接受过 CXL 治疗的患者年轻（平均 24.0±7.8 岁）（P<0.001）。多变量分析显示，与白人患者相比，黑人患者接受 KCN CXL 的可能性降低 63%（OR：0.37，95%CI，0.18-0.79），年龄增长对接受 CXL 治疗具有保护作用（OR：每增加 1 岁，接受 CXL 的可能性降低 0.89，95%CI，0.86-0.93）。按种族比较特征显示，与白种人或亚洲人相比，黑人患者在基线时的视力明显较差，角膜曲率指数（K1、K2 和 Kmax）较高，角膜厚度较薄。
在这个来自三级转诊中心的 KCN 临床患者队列中，黑人患者接受 CXL 的可能性较低，推测是因为他们在就诊时的疾病更严重。可能需要更早地进行主动人群筛查，以便在这些患者不符合治疗标准并出现不可逆视力丧失之前识别和治疗他们。这些策略可能会改善 KCN 管理中的健康公平性。
