Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis

Srujana Sahebjada; Haitham H Al-Mahrouqi; Sophia Moshegov; Sathiya M Panchatcharam; Elsie Chan; Mark Daniell; Paul N Baird

doi:10.1007/s00417-021-05081-8

Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis

Graefes Arch Clin Exp Ophthalmol. 2021 Aug;259(8):2057-2067. doi: 10.1007/s00417-021-05081-8. Epub 2021 Jan 23.

Authors

Srujana Sahebjada^#^{1

2

3}, Haitham H Al-Mahrouqi⁴, Sophia Moshegov^{5

6}, Sathiya M Panchatcharam⁷, Elsie Chan^{5

6

8}, Mark Daniell^{5

6

8}, Paul N Baird⁵

Affiliations

¹ Department of Surgery, Ophthalmology, The University of Melbourne, Level 7, 32 Gisborne St, East Melbourne, VIC, 3002, Australia. Srujana.sahebjada@unimelb.edu.au.
² Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 7, 32 Gisborne St, East Melbourne, VIC, 3002, Australia. Srujana.sahebjada@unimelb.edu.au.
³ Centre for Eye Research Australia, Melbourne, Australia. Srujana.sahebjada@unimelb.edu.au.
⁴ Al-Nahdha Hospital, Ministry of Health, Muscat, Oman.
⁵ Department of Surgery, Ophthalmology, The University of Melbourne, Level 7, 32 Gisborne St, East Melbourne, VIC, 3002, Australia.
⁶ Centre for Eye Research Australia, Melbourne, Australia.
⁷ Oman Medical Specialty Board, Muscat, Oman.
⁸ Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

^# Contributed equally.

PMID: 33484296
DOI: 10.1007/s00417-021-05081-8

Abstract

Purpose: Keratoconus is a potentially blinding condition that slowly deforms the cornea in young people. Despite the increasing prevalence of keratoconus, the exact aetiology of the condition is unknown. This first systematic review examines the evidence of eye rubbing and its association with keratoconus and presents the findings of the meta-analysis.

Methods: Two independent reviewers searched the electronic databases for all potential articles published from 1st of January 1900 to 31st of July 2020 on eye rubbing and keratoconus. The researchers assessed the methodological quality of the studies using the Newcastle-Ottawa scale for observational studies. The assessment for statistical heterogeneity was estimated using chi-square and I-square (I²) tests. A p value of < 0.05 was considered as statistically significant and I² < 30% as homogenous. Begg funnel plot was used to interpret the asymmetry or small study effects.

Results: Eight case-control studies were included in this systematic review. Two studies assessed eye rubbing without odds ratios and thus were excluded. The pooled odds ratios for the six remaining studies included in the meta-analysis was 6.46 (95% CI 4.12-10.1). The study results were heterogenous (I² = 71.69 [95% CI 35.14-87.88]). All the studies scored moderate quality methodology on the Newcastle-Ottawa scale. Begg funnel plot showed asymmetry supporting heterogeneity.

Conclusion: Eye rubbing showed consistent association with keratoconus. However, the current evidence is limited to only a small number of case-control studies which present as heterogeneous and of sub-optimal methodological quality. Additionally, the cause-effect temporal relationship cannot be determined. Further studies are needed to address this intricate relationship of eye rubbing and its induction, ongoing progression, and severity of keratoconus.

Keywords: Aetiology; Eye rubbing; Keratoconus; Meta-analysis; Review; Risk factor.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adolescent
Case-Control Studies
Cornea
Humans
Keratoconus* / diagnosis
Keratoconus* / epidemiology
Keratoconus* / etiology
Odds Ratio
Prevalence

Grants and funding

APP1187763/NHRMC