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Prevalence of keratoconus in paediatric patients in Riyadh, Saudi Arabia
  1. Emilio Almeida Torres Netto1,2,3,4,
  2. Wafa Majed Al-Otaibi5,6,
  3. Nikki L Hafezi2,3,
  4. Sabine Kling1,2,3,
  5. Haya M Al-Farhan5,
  6. J Bradley Randleman7,8,
  7. Farhad Hafezi1,2,3,8,9
  1. 1 Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland
  2. 2 ELZA Institute, Dietikon, Switzerland
  3. 3 Light for Sight Foundation, Zurich, Switzerland
  4. 4 Department of Ophthalmology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
  5. 5 Collage of Applied Medical Sciences, Department of Optometry and Visual Sciences, King Saud University, Riyadh, Saudi Arabia
  6. 6 Salus University, Graduate Program in Biomedicine, Optometry, Elkins Park, Pennsylvania, USA
  7. 7 Department of Ophthalmology, University of Southern California, Los Angeles, California, USA
  8. 8 Ophthalmology, USC Roski Eye Institute, Los Angeles, California, USA
  9. 9 Ophthalmology, Wenzhou Medical University, Wenzhou, China
  1. Correspondence to Professor Farhad Hafezi, ELZA Institute Dietikon Switzerland ; fhafezi{at}


Background/aim Keratoconus (KC) is a ectatic corneal disorder with marked progression during childhood and puberty that may lead to severe visual loss. In addition to KC prevalence, estimate shows major geographical variations; recent studies using Scheimpflug technology are in contrast to the 1980s and 1990s literature. The present study aims to determine the prevalence of KC in paediatric patients in Riyadh, Saudi Arabia (KSA).

Methods This prospective, cross-sectional, observational, multicentre study collected data from paediatric patients from 6 years and 21 years of age who were seen at multiple non-ophthalmic emergency departments within KSA. Bilateral corneal measurements were performed using a rotational Scheimpflug corneal tomography system. Two masked examiners established the diagnosis of KC using both objective and subjective screening criteria. Cohen’s kappa coefficient (κ) was used to qualitatively analyse the interexaminer agreement.

Results There were 522 patients (1044 eyes) evaluated, with an average age of 16.8±4.2 years (range 6–21 years). KC prevalence was 5.56% for examiner 1 and 3.83% for examiner 2. The κ was 0.81 (almost perfect agreement), with discrepancy in nine cases, which were jointly evaluated and consensus obtained. Final KC prevalence was 4.79% (95% CI 2.96 to 6.62) or 1:21 patients.

Conclusions The prevalence of KC among paediatric patients in the KSA is considerably higher than numbers reported from earlier studies and from similar studies in other countries. This increase might be due to geographical variations in disease prevalence or due to the ability of screening technology to detect undiagnosed KC with greater accuracy.

  • cornea
  • epidemiology
  • imaging
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  • Contributors Research design: WMA-O, NLH and FH; data acquisition and/or research execution: EATN and WMA-O; data analysis and/or interpretation: EATN, SK, JBR and FH; and manuscript preparation: all authors.

  • Funding Light for Sight Foundation, Zurich, Switzerland. Deanship of Scientific Research, King Saud University, Saudi Arabia.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The was approved by the ethical committee at Prince Sultan Military Medical City (PSMMC), King Saud Medical City (KSMC) and King Faisal Specialist Hospital & Research Center (KFSH & RC) in Riyadh, Saudi Arabia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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