Keratokonus Variabiliät und Diversität - der Einfluss sozioökonomischer Faktoren auf die Diagnosestellung von Keratokonus

1. Background Keratoconus is a progressive, bilateral corneal disease that leads to thinning and deformation of the cornea, causing irregular astigmatism and significant visual impairment. Despite the clinical relevance, there is limited demographic and geographic data on keratoconus, especially regarding patient care in Austria. This gap data complicates targeted prevention and optimization of therapeutic approaches for affected patients. 2. Purpose The study aimed to document the clinical stage of keratoconus at the time of the first consultation with an ophthalmologist or in the specialized keratoconus clinic at Kepler University Hospital. In addition, potential demographic and geographic factors influencing the early diagnosis and treatment of the disease were identified. By analyzing these factors, the study sought to identify gaps in care to contribute to the future optimization of early detection and treatment of keratoconus. 3. Setting This study was conducted prospectively at the Johannes Kepler University Clinic Linz, Department of Ophthalmology and Optometry. 4. Methods This monocentric cross-sectional study assessed socioeconomic factors, quality of life, and objective measurement parameters in patients with keratoconus. In total, 210 eyes from 105 patients with a mean age of 33.3 years were included. Clinical data, including best distance-corrected visual acuity, contact lens use, and history of corneal cross-linking (CXL), were obtained from medical records. Corneal parameters, including Kmax anterior (D) and Kmax posterior curvature (D), thinnest pachymetry (Thmin), and epithelial thickness index (ETI), were derived from swept-source OCT imaging (MS-39, CSO, Italy. Socioeconomic and geographical information was collected via structured questionnaire, and quality of life was assessed using two questionnaires: a specially developed questionnaire to assess socioeconomic and geographical factors, and the Rasch-validated KORQ questionnaire to assess quality of life and subjective symptoms. 5. Results This study identified significant regional differences in MS-39 derived parameters and best-corrected visual acuity among keratoconus patients. Contrary to expectations, the least favorable corneal and visual outcomes were observed in patients from small and medium-sized urban centers rather than peripheral regions, while the best results occurred in regional centers. These findings suggest that socioeconomic and structural determinants, rather than geographic location alone, substantially influence diagnostic and clinical outcomes. The results underscore the need for equitable access to ophthalmological care and further research into the complex interplay between regional, socioeconomic, and demographic factors in keratoconus. 6. Conclusion This study demonstrates that keratoconus presents with measurable variations in corneal parameters and is associated with specific socioeconomic characteristics in the studied population. Early identification using MS-39 and structured clinical assessment allows for timely interventions, including contact lens fitting and corneal-crosslinking, which may improve visual outcomes. These findings emphasize the importance of comprehensive evaluation in both clinical and socioeconomic contexts for optimal management of keratoconus patients.