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Clinical science
Predictors of progression in untreated keratoconus: a Save Sight Keratoconus Registry study
  1. Alex Ferdi1,
  2. Vuong Nguyen1,
  3. Himal Kandel1,
  4. Jeremy C K Tan2,
  5. Francisco Arnalich-Montiel3,
  6. Marco Abbondanza4,
  7. Stephanie Watson1
  1. 1The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia
  2. 2Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
  3. 3Cornea & External Eye Diseases, Hospital Universitario Ramón y Cajal Biblioteca, Madrid, Spain
  4. 4Abbondanza Eye Center, Rome, Italy
  1. Correspondence to Dr Alex Ferdi, The University of Sydney Save Sight Institute, Sydney, New South Wales, Australia; alexander.ferdi{at}sydney.edu.au

Abstract

Aims We set out to identify risk factors for progression in untreated keratoconus patients from 34 centres across Australia, New Zealand, Spain and Italy.

Methods Patients were divided into ‘progressors’ and ‘stable’ patients for each clinical parameter: visual acuity (VA), steepest keratometry (maximum keratometry (Max-K)) and thinnest corneal thickness (TCT). Primary outcomes were the proportion of eyes with sustained progression in VA, Max-K or TCT within 3 years. Secondary outcomes included predictors of progression.

Results There were 3994 untreated eyes from 2283 patients. The proportion of eyes with VA, Max-K and TCT progression at 1 year were 3.2%, 6.6% and 3.1% respectively. Factors associated with VA loss were higher baseline VA (HR 1.15 per logMAR line increase in VA; p<0.001) and steeper baseline Max-K (HR 1.07 per 1D increase; p<0.001). Younger baseline age was associated with Max-K steepening (HR 0.96 per year older; p=0.001). Thicker baseline TCT, steeper baseline Max-K and younger baseline age were associated with TCT thinning: (HR 1.08 per 10 µm increase in TCT; p<0.001), (HR 1.03 per 1D increase; p=0.02) and (HR 0.98 per year younger; p=0.01), respectively.

Conclusions Steeper Max-K and younger age were the most clinically useful baseline predictors of progression as they were associated with worsening of two clinical parameters. Every 1D steeper Max-K was associated with a 7% and 3% greater risk of worsening VA and thinning TCT, respectively. Each 1 year younger was associated with a 4% and 2% greater risk of steepening Max-K and thinning TCT, respectively.

  • cornea
  • epidemiology

Data availability statement

Data are available upon reasonable request. Deidentified participant data are available upon reasonable request.

https://doi.org/10.1136/bjophthalmol-2020-317547

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    Data availability statement

    Data are available upon reasonable request. Deidentified participant data are available upon reasonable request.

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    Footnotes

    • Twitter @kandelhimal, @profswatson

    • Contributors Conception or design of the work: AF, VN, HK, FA-M, MA, SW. Data collection: AF, HK, FA-M, MA, SW, JCKT. Data analysis and interpretation AF, VN, HK, FA-M, SW. Drafting the article: AF, VN, HK, SW. Critical revision of the article: AF, VN, HK, JCKT, FA-M, MA, SW. Final approval of the version to be published: AF, VN, HK, JCKT, FA-M, MA, SW.

    • Funding This work was supported by the Northcote Trust, Sydney Medical School Foundation, The Ophthalmic Research Institute of Australia (ORIA) and Larry Kornhauser. Grant numbers: not applicable.

    • Competing interests None declared.

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