圆锥角膜患者中黑人和非黑人患者在临床表现及治疗方面的比较
A Comparison of Black and Non-Black Patients in the Presentation and Treatment of Keratoconus.
作者信息
Christensen Michael, Kartchner Jeffrey, Giegengack Matthew, Thompson Atalie C
机构信息
Wake Forest University School of Medicine, Winston Salem, NC, USA.
Department of Surgical Ophthalmology, Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
出版信息
Clin Ophthalmol. 2024 Jan 26;18:259-267. doi: 10.2147/OPTH.S447036. eCollection 2024.
PURPOSE
Patients with advanced keratoconus (KCN) are less likely to benefit from corneal cross-linking and may require a partial or full thickness keratoplasty. This study aimed to determine whether racial disparities exist in the clinical presentation and initial treatment recommendations for patients evaluated for KCN.
METHODS
A single-center retrospective review was conducted on all patients who presented to the cornea department for initial evaluation of KCN between 2018 and 2020. Patients who had undergone prior corneal procedures or surgeries were excluded. Baseline sociodemographic and clinical information was collected and stratified according to black versus non-black race. Generalized estimating equations were used to examine the association between black race and presenting corrected distance visual acuity (CDVA), presence of corneal scarring, keratometry values, Belin ABCD score, and treatment recommendations. Multivariate models were adjusted for patient demographics.
RESULTS
A total of 128 patients (251 eyes) were included in this study. In fully adjusted models, black individuals presented with significantly worse CDVA (p < 0.0001) and worse tomographic KCN staging according to the Belin ABCD criteria (p = 0.002) compared to non-blacks. Blacks were also more than four times as likely to present with a thinnest pachymetry <400 µm (p < 0.0001) and more than three times as likely to have corneal scarring (p = 0.001). Blacks were more than seven times more likely to have keratoplasty recommended as treatment than conservative management such as corneal cross-linking or contact lenses (p = 0.004).
CONCLUSION
Compared with their non-black counterparts, blacks presented with significantly more advanced KCN, which placed them at risk of requiring more invasive treatment plans. Future studies should investigate reasons for such late presentations and aim to mitigate disparities in the presentation and management of KCN.
目的
晚期圆锥角膜（KCN）患者从角膜交联中获益的可能性较小，可能需要进行部分或全层角膜移植术。本研究旨在确定在接受KCN评估的患者的临床表现和初始治疗建议中是否存在种族差异。
方法
对2018年至2020年间到角膜科进行KCN初始评估的所有患者进行单中心回顾性研究。排除既往接受过角膜手术的患者。收集基线社会人口统计学和临床信息，并根据黑人与非黑人种族进行分层。使用广义估计方程来检验黑人种族与呈现的矫正远视力（CDVA）、角膜瘢痕的存在、角膜曲率计值、贝林ABCD评分以及治疗建议之间的关联。多变量模型针对患者人口统计学进行了调整。
结果
本研究共纳入128例患者（251只眼）。在完全调整的模型中，与非黑人相比，黑人的CDVA明显更差（p < 0.0001），根据贝林ABCD标准，其断层扫描KCN分期更差（p = 0.002）。黑人出现最薄角膜厚度<400 µm的可能性是非黑人的四倍多（p < 0.0001），有角膜瘢痕的可能性是非黑人的三倍多（p = 0.001）。与角膜交联或隐形眼镜等保守治疗相比，黑人被推荐进行角膜移植术治疗的可能性是非黑人的七倍多（p = 0.004）。
结论
与非黑人相比，黑人的KCN病情明显更严重，这使他们面临需要更具侵入性治疗方案的风险。未来的研究应调查这种晚期表现的原因，并旨在减少KCN的表现和管理方面的差异。
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