Factors associated with keratoconus in Israel-A cross-sectional population-based study

Or Ben-Shaul; Adi Segal; Sharon Schwartz; Nili Stein; Michael Hyams; Walid Saliba; Michael Mimouni

doi:10.1111/aos.16706

Factors associated with keratoconus in Israel-A cross-sectional population-based study

Acta Ophthalmol. 2024 May 14. doi: 10.1111/aos.16706. Online ahead of print.

Authors

Or Ben-Shaul^{1

2}, Adi Segal¹, Sharon Schwartz¹, Nili Stein³, Michael Hyams¹, Walid Saliba^{2

3}, Michael Mimouni^{2

4}

Affiliations

¹ Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel.
² Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
³ Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.
⁴ Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.

PMID: 38742987
DOI: 10.1111/aos.16706

Abstract

Purpose: To identify potential factors associated with keratoconus.

Methods: This cross-sectional study included data from Israel's largest healthcare provider for the years 2005-2020. Keratoconus patients and age-matched controls were identified. Demographic factors and comorbid conditions, including smoking, diabetes mellitus, asthma, myalgia, mental retardation, Down syndrome, atopic dermatitis and allergy/allergic rhinitis, were compared between the two cohorts. The independent risk factors associated with keratoconus were determined using a multivariable conditional logistic regression model.

Results: Overall, 145 508 subjects were reviewed of which 13 228 were keratoconus patients. A ten-fold group (n = 132 280) of age-matched control subjects served as controls for comparisons. In multivariable analysis, several factors were found to be significantly associated with keratoconus. Male gender (OR = 1.27, p < 0.001), Arab ethnicity (OR = 1.50, p < 0.001), diabetes (OR = 1.19, p < 0.001), asthma (OR = 1.50, p < 0.001), myalgia (OR = 1.09, p = 0.02), mental retardation (OR = 2.63, p < 0.001), atopic dermatitis (OR = 1.35, p < 0.001) and allergic rhinitis (OR = 1.21, p < 0.001) were significantly associated with keratoconus. Smoking was significantly protective of keratoconus (OR = 0.66, p < 0.001).

Conclusions: This population-based study reports male gender, Arab ethnicity, diabetes, asthma, myalgia, mental retardation/Down syndrome, atopic dermatitis and allergic rhinitis as factors associated with keratoconus while smoking demonstrates a protective effect. The results of this study could guide enhanced screening strategies and early interventions, particularly for high-risk groups.

Keywords: epidemiology; keratoconus; risk factors.