Prevalence and clinical profile of keratoconus in patients presenting at a provincial hospital in KwaZulu, Natal, South Africa: A case study

Authors

DOI:

https://doi.org/10.4081/jphia.2023.2356

Keywords:

Keratoconus, vernal keratoconjunctivitis, prevalence, central corneal thinning, corneal scarring

Abstract

Keratoconus (KC) is a progressive, asymmetrical corneal disease, characterized by stromal thinning that leads to distortion, causing vision loss. The visual loss is secondary to corneal scarring, irregular astigmatism, and myopia. The prevalence of KC has been reported to differ in different parts of the world. The study aimed to determine the prevalence and profile of patients with KC presenting to a provincial hospital in KwaZulu‑Natal, South Africa. A retrospective study design was used to review 412 clinical records of patients attending the McCord Provincial Eye Hospital (MPEH) during a five‑year period (2016‑2020). Data on age, race, refraction, clinical profile, treatment plan, and diagnosis were ascertained. The prevalence of KC in MPEH was found to be 13.7% with a mean age of 24.7±7.94 years. Black African and females had a higher frequency of KC compared to males and other ethnic groups. Most of the patients presented with a severe stage of KC and referral was the most common management. Central corneal thinning and Munson's sign were the most prevalent clinical signs. There was no statistically significant difference between the worse and better eye when comparing the clinical signs. The prevalence and clinical profile of patients with KC in this study was similar to that reported by previous studies and more in Blacks and females. Population based epidemiological studies are needed to determine the prevalence of KC in South Africa to enable early clinical interventions.

Download data is not yet available.

Author Biography

Rekha Hansraj, Discipline of Optometry, School of Health Science, University of KwaZulu‑Natal, Durban

 

 

References

Kummelil MK, Hemamalini MS, Bhagali R, Sargod K, Nagappa S, Shetty R and Shetty BK: Toric implantable collamer lens for keratoconus. Indian J Ophthalmol 61: 456‑460, 2013.

Arne JL and Fournié P: Keratoconus, the most common corneal dystrophy. Can keratoplasty be avoided? Bull Acad Natl Med 195: 113‑129, 2011 (In French).

Weed KH, MacEwen CJ, Giles T, Low J and McGhee CN: The Dundee University Scottish keratoconus study: Demographics, corneal signs, associated diseases, and eye rubbing. Eye (Lond) 22: 534‑541, 2008.

Godefrooji DA, de Wit GA, Uiterwaal CS, Imhof SM and Wisse RP: Age‑specific incidence and prevalence of keratoconus: A nationwide registration study. Am J Ophthalmol 175: 169‑172, 2017.

Sharma N, Rao K, Maharana PK and Vajpayee RB: Ocular allergy and keratoconus. Indian J Ophthalmol 61: 407‑409, 2013.

Kok YO, Tan GF and Loon SC: Review: Keratoconus in Asia. Cornea 31: 581‑593, 2012.

Gillan WDH: Keratoconus: A clinical exposé. S Afr Optom 72: 41‑45, 2013.

Rabinowitz YS: Keratoconus. Surv Ophthalmol 42: 297‑319, 1998.

Maeda N, Klyce SD, Smolek MK and Thompson HW: Automated keratoconus screening with corneal topography analysis. Invest Ophthalmol Vis Sci 35: 2749‑2757, 1994.

Kennedy RH, Bourne WM and Dyer JA: A 48‑year clinical and epidemiologic study of keratoconus. Am J Ophthalmol 101: 267‑273, 1986.

Nielsen K, Hjortdal J, Nohr EA and Ehlers N: Incidence and prevalence of keratoconus in Denmark. Acta Ophthalmol Scand 85: 890‑892, 2007.

Bak‑Nielsen S, Ramlau‑Hansen CH, Ivarsen A, Plana‑Ripoll O and Hjortdal J: Incidence and prevalence of keratoconus in Denmark. Acta Ophthalmol 97: 752‑755, 2019.

Millodot M, Shneor E, Albou S, Atlani E and Gordon‑Shaag A: Prevalence and associated factors of keratoconus in Jerusalem: A Cross‑sectional Study. Ophthalmic Epidemiol 18: 91‑97, 2011.

Mugho SN, Ilako D and Nyenze EM: Prevalence of keratoconus in patients with allergic conjunctivitis attending Kenyatta National Hospital eye clinic. JOECSA 21: 18‑23, 2016.

Espandar L and Meyer J: Keratoconus: Keratoconus: Overview and update on treatment. Middle East Afr J Ophthalmol 17: 15‑20, 2010.

Holland DR, Maeda N, Hannush SB, Riveroll LH, Green MT, Klyce SD and Wilson SE: Unilateral keratoconus. Incidence and quantitative topographic analysis. Ophthalmology 104: 1409‑1413, 1997.

Lim X, Rabinowitz YS, Rasheed K and Yang H: Longitudinal study of the normal eyes in unilateral keratoconus patients. Ophthalmology 111: 440‑446, 2004.

Duncan JK, Belin MW and Borgstrom M: Assessing progression of keratoconus: Novel tomographic determinants. Eye Vis (Lond) 3: 6, 2016.

Vinciguerra R, Ambrósio R Jr, Elsheikh A, Roberts CJ, Lopes B, Morenghi E, Azzolini C and Vinciguerra P: Detection of keratoconus with a new biomechanical index. J Refract Surg 32: 803‑810, 2016.

Romero‑Jiménez M, Santodomingo‑Rubido J and Wolffsohn JS: Keratoconus: A review. Contact Lens and Anterior Eye 33: 157‑166, 2010.

Barsam A, Petrushkin H, Brennan N, Bunce C, Xing W, Foot B and Tuft S: Acute corneal hydrops in keratoconus: A national prospective study of incidence and management. Eye (Lond) 29: 469‑474, 2015.

Amsler M: Le kératocône fruste au Javal. Ophthalmologica 96: 77‑83, 1938.

Mcmahon TT, Szczotka‑Flynn L, Barr J, Anderson R, Slaughter M, Lass J and Iyengar S: A new method for grading the severity of keratoconus. Cornea 25: 794‑800, 2006.

Belin M and Duncan J: Keratoconus: The ABCD grading system. Int J Kerat Ect Cor Dis 4: 85‑93, 2015.

Wagner H, Barr JT and Zadnik K: Collaborative longitudinal evaluation of keratoconus (CLEK) Study: Methods and findings to date. Cont Lens Anterior Eye 30: 223‑232, 2007.

Zhang XH and Li X: Effect of rigid gas permeable contact lens on keratoconus progression: A review. Int J Ophthalmol 13: 1124‑1131, 2020.

Saraç Ö, Kars ME, Temel B and Çağıl N: Clinical evaluations of different types of contact lenses in keratoconus management. Cont Lens Anterior Eye 42: 482‑286, 2019.

Hoyer A, Raiskup‑Wolf F, Sporl E and Pillunat LE: Collagen cross‑linking with riboflavin and UVA light in keratoconus‑results from Dresden. Ophthalmologe 106: 133‑140, 2009 (In German).

York NJ and Tinley C: Corneal donations in South Africa: A 15‑year review. S Afr Med J 107: 697‑701, 2017.

Bezabih L, Abebe TW and Fite RO: Prevalence and factors associated with childhood visual impairment in Ethiopia. Clin Ophthalmol 11: 1941‑1948, 2017.

Rupnarain S, Madlala N, Memela N, Ngcobo S, Shabalala N, Simjee N, Gcabashe N and Rampersad N: Clinical characteristics of keratoconus patients at the University of KwaZulu‑Natal eye clinic. African Vision and Eye Health 9: 7, 2020.

Chetty E and Rubin A: Preliminary demographics for patients with keratoconus attending a university‑based clinic in Johannesburg, South Africa. South Africa. Afr Vision Eye Health: 78, 2019.

Hashemi H, Khabazkhoob M, Yazdani N, Ostadimoghaddam H, Norouzirad R, Amanzadeh K, Miraftab M, Derakhshan A and Yekta A: The prevalence of keratoconus in a young population in Mashhad, Iran. Ophthalmic Physiol Opt 34: 519‑527, 2014.

Shneor E, Millodot M, Gordon‑Shaag A, Essa M, Anton M, Barbara R and Barbara A: Prevalence of Keratoconus among Young Arab Students in Israel. Int J Keratoconus Ectatic Corneal Dis 3: 9‑14, 2014.

Netto TEA, Al‑Otaibi WM, Hafezi NL, Kling S, Al‑Farhan HM, Randleman JB and Hafezi F: Prevalence of keratoconus in paediatric patients in Riyadh, Saudi Arabia. Br J Ophthalmol 102: 1436‑1441, 2018.

Ljubic A: Keratoconus and its prevalence in Macedonia. Macedonian J Med Sci 2: 58, 2009.

Kristianslund O, Hagem AM, Thorsrud A and Drolsum L: Prevalence and incidence of keratoconus in Norway: A nationwide register study. Acta Ophthalmol 99: 694‑699, 2021.

Naderan M, Shoar S, Rezagholizadeh F, Zolfaghari M and Naderan M: Characteristics and associations of keratoconus patients. Cont Lens Anterior Eye 38: 199‑1205, 2015.

Lucas SEM and Burdon KP: Genetic and environmental risk factors for keratoconus. Annu Rev Vis Sci 6: 25‑46, 2020.

Rashid ZA, Millodot M and Evans KS: Characteristics of keratoconic patients attending a specialist contact lens clinic in Kenya. Middle East Afr J Ophthalmol 23: 283‑287, 2016.

Khor WB, Wei RH, Lim L, Chan CM and Tan DTH: Keratoconus in Asians: Demographics, clinical characteristics and visual function in a hospital‑based population. Clin Exp Ophthalmol 39: 299‑307, 2011.

Mohd‑Ali B, Abdu M, Das S and Mohidin N: Ethnicity related to keratoconus: A study with clinical implications. Int Med J 18: 237‑240, 2011.

Kapur N, Hunt I, Lunt M, McBeth J, Creed F and Macfarlane G: Primary care consultation predictors in men and women: A cohort study. Br J Gen Pract 55: 108‑113, 2005.

Bertakis KD, Azari R, Helms LJ, Callahan EJ and Robbins JA: Gender differences in the utilization of health care services. J Fam Pract 49: 147‑152, 2000.

Valdez‑García JE, Sepúlveda R, Salazar‑Martínez JJ and Lozano‑Ramírez JF: Prevalence of keratoconus in an adolescent population. Revista Mexicana de Oftalmología 88: 95‑98, 2014.

Ertan A and Muftuoglu O: Keratoconus clinical findings according to different age and gender groups. Cornea 27: 1109‑1113, 2008.

Pearson AR, Soneji B, Sarvananthan N and Sandford‑Smith JH: Does ethnic origin influence the incidence or severity of keratoconus? Eye (Lond) 14: 625‑628, 2000.

Georgiou T, Funnel CL, Cassels‑Brown A and O'Conor R: Influence of ethnic origin on the incidence of keratoconus and associated atopic disease in Asian and white patients. Eye (Lond) 18: 379‑383, 2004.

Tuft SJ, Moodaley LC, Gregory WM, Davison CR and Buckley RJ: Prognostic factors for the progression of keratoconus. Ophthalmology 101: 439‑447, 1994.

Mhlanga D and Garidzirai R: The influence of racial differences in the demand for healthcare in South Africa: A case of public healthcare. Int J Environ Res Public Health 17: 5043, 2020.

Abdu M, Binnawi KH, Elmadina AM and Hassan R: Clinical profile of keratoconus patients in Sudan. Sudanese J Ophthalmol 8: 20‑25, 2016.

Serdarogullari H, Tetikoglu M, Karahan H, Altin F and Elcioglu M: Prevalence of keratoconus and subclinical keratoconus in subjects with astigmatism using pentacam derived parameters. J Ophthalmic Vis Res 8: 213‑219, 2013.

Mahadevan R, Arumugam AO, Arunachalam V and Kumaresan B: Keratoconus‑a review from a Tertiary Eye‑care center. J Optom 2: 166‑172, 2009.

Larkey LK, Hecht ML, Miller K and Alatorre C: Hispanic cultural norms for health‑seeking behaviors in the face of symptoms. Health Educ Behav 28: 65‑80, 2001.

Persoskie A, Ferrer RA and Klein WM: Association of cancer Worry and perceived risk with doctor avoidance: An analysis of information avoidance in a nationally representative US sample. J Behav Med 37: 977‑987, 2014.

Maake ME and Moodley VR: An evaluation of the public sector optometric service provided within the health districts in KwaZulu‑Natal. South Africa. Afr Vision Eye Health 77: 407, 2018.

Elmassry A, Osman A, Sabry M, Elmassry M, Katkat M, Hatata MY and El‑Kateb M: Corneal endothelial cells changes in different stages of Keratoconus: A multi‑Centre clinical study. BMC Ophthalmol 21: 143, 2021.

Salooti R and Amir J: Characteristics of keratoconus patients in Shiraz. BINA Journa 7: 19‑24, 2001.

Lim N and Vogt U: Characteristics and functional outcomes of 130 patients with keratoconus attending a specialist contact lens clinic. Eye (Lond) 16: 54‑59, 2002.

Gcabashe N, Moodley VR and Hansraj R: Keratoconus management at public sector facilities in KwaZulu‑Natal, South Africa: Practitioner perspectives. Afr Vision Eye Health 81: a698, 2022.

Downloads

Published

30-08-2023

How to Cite

Gcabashe, N. M., Moodley , V. R., & Hansraj, R. (2023). Prevalence and clinical profile of keratoconus in patients presenting at a provincial hospital in KwaZulu, Natal, South Africa: A case study. Journal of Public Health in Africa, 14(11). https://doi.org/10.4081/jphia.2023.2356

Issue

Section

Original Articles