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Mousa RM, Saif MYS, Said MAE, Mohamed Taher RM. Prevalence of Keratoconus and Characteristics of Refractive Errors in First-Degree Relatives of Patients With Keratoconus Among Egyptians. Cornea 2024:00003226-990000000-00577. [PMID: 38886885 DOI: 10.1097/ico.0000000000003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/05/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE This study investigated the occurrence of keratoconus among first-degree relatives of patients with keratoconus and evaluated their refractive characteristics. METHOD A cross-sectional observational study was conducted on 248 relatives of 52 patients with keratoconus in whom bilateral eye analysis was conducted. Corneal tomography was performed for all participants with a comprehensive analysis of various parameters, including K1, K2, Kmax, elevation, skewing, and thinnest location. In addition, the following data were also analyzed: uncorrected visual acuity, corrected distance visual acuity, refraction measurements alongside a slit-lamp examination, and fundus examination. RESULTS Among 248 participants, 19 (7.7%) had keratoconus, 3.2% had forme fruste, and 15.3% had suspected keratoconus. Among all studied cases, 73.8% had normal corneas. Significant differences (P = 0.001) were found in the distribution of keratoconus prevalence among brothers, mothers, sons, and sisters (13.6%, 4.3%, 5.6%, and 12.1%, respectively). The presence of refractive errors also showed significant differences between the relatives (P = 0.03). CONCLUSIONS Increased keratoconus prevalence among relatives of patients with keratoconus indicates the vulnerability of this population to the development of the disease, necessitating early screening of this group for detection of keratoconus as early as possible.
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Sahın Vural G, Bolat H. Nanopore sequencing method for CTG18.1 expansion in TCF4 in late-onset Fuchs endothelial corneal dystrophy and a comparison of the structural features of cornea with first-degree relatives. Graefes Arch Clin Exp Ophthalmol 2024; 262:903-911. [PMID: 37747538 DOI: 10.1007/s00417-023-06243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To evaluate the relationship between the number of trinucleotide repeats (TNR) in late-onset Fuchs corneal endothelial dystrophy (FCED) and to compare the endothelial properties of FCED, first-degree relatives, and controls. METHODS Blood samples were collected from FCEDs to determine TNR number. The FCED patients, first-degree relatives, and controls were examined with specular microscopy for central corneal thickness (CCT), endothelial cell density (ECD), pleomorphism and polymegatism, and with corneal topography for specific indicators such as (i) displacement of thinnest point of cornea, (ii) loss of isopachs, (iii) focal posterior surface depression towards anterior chamber. RESULTS This study included 92 patients with FCED, 92 first-degree relatives, and 96 controls. CCT was thickest in FCEDs (558.0 μm) (p < 0.05) while there was no difference between relatives (533.0 μm) and controls (530.4 μm) (p = 0.845). ECD was decreased in both FCED (2069.2 mm2) and relatives (2171.4 mm2) than controls (2822.9 mm2) (p < 0.05 in both). The presence of pleomorphism and polymegatism was significant in patients with FCED (93.4% and 93.4%, respectively), relatives (86.9% and 86.04%, respectively), and controls (8.33% and 1.04%, respectively) (p < 0.05). Specific topographic indicators differed among the groups (p < 0.05). The mean repeat number of the FCED patients was 17.48 ± 4.54 (12-25) times. The TNR number of FCED cases correlated with the relative CCT (p < 0.05, R = 0.615) and cell density (p = 0.009, R = -0.499). CONCLUSIONS A strong association between the corneal endothelium in relatives and TNR number of FCEDs was defined. Relatives tended to have fewer corneal endothelial cells, even though they did not have clinical findings.
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Affiliation(s)
- Gozde Sahın Vural
- Department of Ophthalmology, Balıkesir University Medicine Faculty, Balıkesir, Turkey.
- Department of Ophthalmology, Balıkesir University Medicine Faculty Hospital, Balıkesir, Turkey.
| | - Hilmi Bolat
- Department of Genetics, Balıkesir University Medicine Faculty, Balıkesir, Turkey
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Li J, Zhang BN, Jhanji V, Wang X, Li D, Du X. Parental Corneal Tomographic and Biomechanical Characteristics of Patients With Keratoconus. Am J Ophthalmol 2023; 256:146-155. [PMID: 37567431 DOI: 10.1016/j.ajo.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To investigate the hereditability of corneal tomographic and biomechanical parameters in keratoconus (KC). DESIGN Prospective cohort study. METHODS This study was conducted at Qingdao Eye Hospital of Shandong First Medical University in Qingdao, China. Forty-four patients with KC and their biological parents (n = 88) were recruited as the study group. The control group consisted of 84 healthy adults with matched age and gender. Both eyes of each participant underwent clinical examinations, and 1 eye was selected for statistical analysis. Exclusion criteria were as follows: individuals with glaucoma, ocular surgery, systemic diseases known to affect the eyes, or poor cooperation during examination. Subjects were asked to discontinue soft contact lens (CL) wear for 2 weeks and rigid gas permeable CL wear for 4 weeks before ocular examination. All participants underwent a comprehensive assessment including Pentacam Scheimpflug tomography, Corvis ST, visual acuity, refraction examination, axial length, and slitlamp examination for both eyes. Individuals presenting with KC manifestations in at least 1 eye were classified as having KC. A total of 9 Pentacam indices including keratometry in the flat/steep meridian (K1/K2), maximal keratometry (Kmax), thinnest point pachymetry (TP), and maximum/average Ambrósio relational thickness (ARTmax/ARTave), anterior and posterior surfaces elevation of the cornea (Ef/Eb) and total deviation value (Final D), and 21 biomechanical indices were collected. Associations of these factors with KC were evaluated using multiple comparison and binary logistics regression analyses. RESULTS Two parents (2.27%) from 2 different families were diagnosed with KC. Parents of patients with KC had thinner corneas with altered corneal biomechanical parameters compared with healthy controls (P < .05). The combined tomographic and biomechanical index demonstrated the highest discriminatory power (area under the receiver operating characteristic curve 0.785) and strong specificity (84.5%). Parental corneal tomographic and biomechanical index, Corvis biomechanical index, and TP were identified as the major influential factors for KC in their offspring by logistic regression analysis, with a 73.3% accuracy in identifying offspring with KC. CONCLUSIONS Parental corneal tomographic and biomechanical properties of patients with KC suggest a possible predisposition to KC. A combination of tomography and corneal biomechanics can be helpful in predicting the incidence rate of KC in the offspring of patients with subclinical KC.
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Affiliation(s)
- Jie Li
- From Eye Institute of Shandong First Medical University (J.L., B.N.Z., X.W., D.L., X.D.), Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China; State Key Laboratory Cultivation Base (J.L., B.N.Z., X.W., D.L., X.D.), Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China; School of Ophthalmology (J.L., B.N.Z., X.W., D.L., X.D.), Shandong First Medical University, Qingdao, Shandong, China
| | - Bi Ning Zhang
- From Eye Institute of Shandong First Medical University (J.L., B.N.Z., X.W., D.L., X.D.), Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China; State Key Laboratory Cultivation Base (J.L., B.N.Z., X.W., D.L., X.D.), Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China; School of Ophthalmology (J.L., B.N.Z., X.W., D.L., X.D.), Shandong First Medical University, Qingdao, Shandong, China
| | - Vishal Jhanji
- Department of Ophthalmology (V.J.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Xiaochuan Wang
- From Eye Institute of Shandong First Medical University (J.L., B.N.Z., X.W., D.L., X.D.), Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China; State Key Laboratory Cultivation Base (J.L., B.N.Z., X.W., D.L., X.D.), Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China; School of Ophthalmology (J.L., B.N.Z., X.W., D.L., X.D.), Shandong First Medical University, Qingdao, Shandong, China
| | - Dewei Li
- From Eye Institute of Shandong First Medical University (J.L., B.N.Z., X.W., D.L., X.D.), Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China; State Key Laboratory Cultivation Base (J.L., B.N.Z., X.W., D.L., X.D.), Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China; School of Ophthalmology (J.L., B.N.Z., X.W., D.L., X.D.), Shandong First Medical University, Qingdao, Shandong, China
| | - Xianli Du
- From Eye Institute of Shandong First Medical University (J.L., B.N.Z., X.W., D.L., X.D.), Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong, China; State Key Laboratory Cultivation Base (J.L., B.N.Z., X.W., D.L., X.D.), Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong, China; School of Ophthalmology (J.L., B.N.Z., X.W., D.L., X.D.), Shandong First Medical University, Qingdao, Shandong, China.
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Yaffe JA, Matlov Kormas R, Malyugin BE, Boyko M, Tuuminen R, Knyazer B. Ethnicity, Progressive Keratoconus, and Outcomes after Corneal Cross-Linking in Southern Israel. Life (Basel) 2023; 13:2294. [PMID: 38137894 PMCID: PMC10744447 DOI: 10.3390/life13122294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To assess clinical outcomes of corneal cross-linking (CXL) intervention in a population diagnosed with progressive keratoconus. METHODS This single-center retrospective cohort study included consecutive patients who underwent standard CXL or accelerated CXL for progressive keratoconus at a major teaching hospital in southern Israel between January 2015 and December 2019. Patients' medical files were reviewed, and pre-operative and post-operative data regarding demographics and clinical and tomographic characteristics were extracted and analyzed. RESULTS This study included 166 patients (representing 198 eyes), out of which 98 patients (123 eyes) were ethnically Bedouin, and 68 patients (75 eyes) were ethnically Jewish. Overall, 126 patients (144 eyes) had a follow-up of at least 12 months (16.84 ± 5.76). The mean patient age was 20.62 ± 7.1 years old. There were significant baseline differences between the two ethnic groups in best-corrected visual acuity (BCVA; p < 0.001), uncorrected visual acuity (UCVA; p < 0.001), mean keratometry (p = 0.028), and corneal thickness (p < 0.001). Significant changes in BCVA, UCVA, and pachymetry parameters within each group were found after 12 months. Negative binomial regression analysis showed a maximal keratometry below 55D (RR = 1.247, p < 0.001), and a standard CXL procedure (RR = 1.147, p = 0.041) are significantly related to the stability of KC after 12 months. However, the effect size of the origin of patients is negligible (RR = 1.047, p = 0.47). CONCLUSIONS In this study, the Bedouin population suffered from more progressive keratoconus when compared to the Jewish population. CXL was significantly effective in improving BCVA and UCVA in both groups after 12 months of follow-up. The effect size of the origin of patients on the stability of KC was found to be negligible.
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Affiliation(s)
- Jacob A. Yaffe
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva 8457108, Israel; (R.M.K.); (B.K.)
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Ran Matlov Kormas
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva 8457108, Israel; (R.M.K.); (B.K.)
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
| | - Boris E. Malyugin
- S. Fyodorov Eye Microsurgery Federal Institution, Moscow 127486, Russia
- Department of Ophthalmology, A. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow 127473, Russia
| | - Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8457108, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Eye Centre, Kymenlaakso Central Hospital, 48210 Kotka, Finland
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva 8457108, Israel; (R.M.K.); (B.K.)
- Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva 8443944, Israel
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Kanclerz P, Przewłócka K, Toprak I, Alio J. The prevalence of keratoconus in northern Poland: A cross-sectional study of patients from a primary healthcare practice. Cont Lens Anterior Eye 2023; 46:101846. [PMID: 37117129 DOI: 10.1016/j.clae.2023.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Keratoconus is defined as central and/or paracentral corneal thinning and steepening with consequent irregular astigmatism. To date, no prospective study has reported its prevalence in Central Europe. This study aimed to evaluate the prevalence of keratoconus assessed with Scheimpflug imaging in a profile of general medicine practice in Poland. METHODS This cross-sectional study collected data by inviting all patients aged 10-80 years subscribed to a single general practitioner in the Elbląg area, Poland. Corneal measurements were performed using a rotating Scheimpflug corneal tomography system. Three masked examiners established the diagnosis of keratoconus in the right or left eye. Fleiss' kappa coefficient (κ) was used to qualitatively analyze the interexaminer agreement. RESULTS Of 1,705 patients invited to the study, 771 agreed to participate (45.2%). The mean age of the 728 patients (60.6% female and 39.4% male) with gradable images in at least one eye was 53.6 ± 16.5 years. All of the examiners classified the same four cases as keratoconus (0.549%, 549 per 100,000, 95% confidence interval 150 to 1,400 per 100,000), of which two were bilateral. Fleiss' kappa showed almost perfect agreement among the three examiners regarding the diagnostic decision (κ = 0.784, 95% confidence interval 0.750 to 0.817, p < 0.001). The keratoconus cases were all women (p = 0.106), aged 48, 69, 70, and 71 years old. CONCLUSION The prevalence of keratoconus in this area was higher than that previously demonstrated in many European countries. Underestimation of the prevalence has been postulated but never demonstrated.
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Affiliation(s)
- Piotr Kanclerz
- Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland; Helsinki Retina Research Group, University of Helsinki, Finland.
| | | | - Ibrahim Toprak
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Jorge Alio
- Vissum Corporation, Avda de Denia S/N 03015, Alicante, Spain
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Alamri A, Alrizqi AA, Aljohani AA, Alzahrani DA, Alassaf OM, Hamzi YA, Alharbi NM, Alharbi BA, Taha M. Awareness of Keratoconus and Its Association With Eye Rubbing Among the Population in Aseer Province. Cureus 2023; 15:e41271. [PMID: 37533612 PMCID: PMC10391695 DOI: 10.7759/cureus.41271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Keratoconus (KC), is a non-inflammatory, bilateral, asymmetrical, progressive disease characterized by ectasia, thinning, increasing corneal curvature, and loss of visual acuity. In Saudi Arabia, it was discovered that KC has been the main reason for corneal transplantation in the past 20 years. Eye rubbing is considered one of the most significant risk factors for KC based on available data. PARTICIPANTS AND METHODS A cross-sectional study was conducted among adults in Aseer province, Saudi Arabia in 2023. Data were collected through a pre-designed online questionnaire consisting of 17 questions divided into three sections. The questionnaire was preceded by informed consent and insured to maintain the confidentiality of the data. RESULTS A total of 498 respondents were included in this study. The majority of the study's participants were in the 18 to 25 age group and females made up the majority. The majority of participants had a university education. 41.6% of individuals reported experiencing an allergic disorder, 59.0% reported having knowledge about KC, and the overall participants' awareness regarding KC was poor at 85.74%, with the highest percentage of good awareness (22.2%) detected among the 18-25 age group. CONCLUSION The study revealed a concerning lack of awareness about KC among the population in Aseer Province, Saudi Arabia. Additionally, a significant percentage of participants engaged in eye rubbing, a behavior associated with increased risk for KC. There is a need for increased awareness about KC and the importance of avoiding eye rubbing.
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Affiliation(s)
- Abdulrahman Alamri
- Department of Ophthalmology, College of Medicine, King Khalid University, Abha, SAU
| | - Amal A Alrizqi
- Department of Medicine and Surgery, Al-Qunfudah College of Medicine, Umm Al-Qura University, Alqunfudhah, SAU
| | - Amal A Aljohani
- Department of Medicine and Surgery, Al-Qunfudah College of Medicine, Umm Al-Qura University, Alqunfudhah, SAU
| | - Danah A Alzahrani
- Department of Medicine and Surgery, College of Medicine, King Khalid University, Abha, SAU
| | - Othman M Alassaf
- Department of Medicine and Surgery, College of Medicine, University of Hail, Hail, SAU
| | - Yazeed A Hamzi
- Department of Medicine and Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Norah M Alharbi
- Department of Medicine and Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Basil A Alharbi
- Department of Surgery, Ar Rass General Hospital, Ar Rass, SAU
| | - Medhat Taha
- Department of Anatomy, Al-Qunfudhah Medical College, Umm Al-Qura University, Makkah, SAU
- Department of Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura, EGY
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Ren S, Yang K, Fan Q, Wang Q, Zhu M, Yin S, Gu Y, Xu L. Bioinformatics analysis of key candidate genes and pathways in Chinese patients with keratoconus. Exp Eye Res 2023; 231:109488. [PMID: 37116607 DOI: 10.1016/j.exer.2023.109488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/10/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
Keratoconus (KC) is a multifactorial disease in which genetic factors played important roles in its pathogenesis. The purpose of the current study was to identify the key candidate genes and pathways in Chinese patients with KC through bioinformatics analysis. Totally, we identified 71 candidate genes by analyzing the results of whole exome sequencing on 51 Chinese patients with KC, combining with previous reports on differential expression at transcription and protein levels in KC. Gene enrichment analysis with GeneCodis demonstrated that two significantly enriched terms including 21 genes in biological process (BP) were detected, and six significantly enriched terms containing 14 genes in Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were discovered. The STRING was utilized to construct the protein-protein interaction (PPI) network of identified genes. The result showed that a PPI network consisted of 14 nodes with 14 edges was constructed, and two gene modules were obtained. Eight hub genes (LAMB3, LAMA3, LAMA1, ITGA6, ITGA3, COL6A3, COL6A2, and COL6A1) were identified as key candidate genes for KC by cytoHubba in Cytoscape. Functional enrichment analysis with ClueGO and CluePedia indicated that the ECM-receptor interaction was the key pathway accounted for KC. The findings might provide novel insights on the genetic basis of KC.
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Affiliation(s)
- Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China; Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institution, Zhengzhou, 450003, China
| | - Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Qing Wang
- Henan University People's Hospital, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, Zhengzhou, 450003, China
| | - Meng Zhu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institution, Zhengzhou, 450003, China
| | - Shanshan Yin
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institution, Zhengzhou, 450003, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
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Clinical-epidemiological characteristics of keratoconus in Asturias. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:65-71. [PMID: 36375756 DOI: 10.1016/j.oftale.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Keratoconus is the most frequent corneal ectasia and second most common cause of keratoplasty worldwide. The clinical and epidemiological characteristics of keratoconus have rarely been studied in Spain, and to date, no study has been done in Asturias. MATERIAL AND METHODS A cross-sectional study was conducted to analyze all cases of keratoconus diagnosed in the first consultations of the Cornea and Surface section of the Hospital Universitario Central de Asturias (Oviedo) and Hospital Universitario de Cabueñes (Gijón) between 2017 and 2020. Demographic data, visual acuity and corneal topography were collected. RESULTS A total of 112 patients (42.0% women and 58.0% men) were included. The mean age was 36.84 ± 15.59, with 39.3% being older than 40 years. 31.8%, 28.0%, 15.0%, and 25.2% were in stages I, II, III and IV, Amsler-Krumeich scale, respectively. Corneal segments were implanted in 7.5% of patients, cross-linking was performed in 4.7%, and keratoplasty was performed in 13.2%. CONCLUSION Approximately 40% of keratoconus cases are detected at advanced stages and another 40% are detected at an age over 40 years. 13% of these patients require keratoplasty, which is why it is frequently performed in our setting. Therefore, early diagnosis before irreversible visual loss is necessary.
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Gideon Abou Said A, Piñero DP, Shneor E. Revisiting the oil droplet sign in keratoconus: Utility for early keratoconus diagnosis and screening. Ophthalmic Physiol Opt 2023; 43:83-92. [PMID: 36394095 PMCID: PMC10099609 DOI: 10.1111/opo.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE An annular dark shadow (ADS) reflex has been observed while performing direct ophthalmoscopy on subjects with keratoconus. This study describes a method that may serve as a diagnostic technique for early keratoconus and may be used as a quantitative measure of severity. METHODS Healthy keratoconic subjects and keratoconus suspects underwent corneal tomography and a full ocular examination. Keratoconus severity was graded based on Belin ABCD criteria. An iPhone camera was connected to a direct ophthalmoscope to take a picture of the eye. The height of the ASD was measured using the AutoCAD software. Differences between subject groups were evaluated by chi-squared and Mann-Whitney tests. Spearman correlation compared ocular parameters and the height of the ADS. A multiple stepwise linear regression was used to predict the height of the ADS based on clinical parameters. RESULTS Fifty-eight subjects participated in this study: 37 healthy controls (37 eyes) and 21 keratoconics or keratoconus suspects (37 eyes). The ADS was present in all keratoconic and keratoconus-suspect eyes but in none of the controls. The height of the ADS was significantly correlated with keratoconus severity. Front corneal surface root mean square of higher order aberrations, sphere and anterior radius of curvature from the front apex curve are significant predictors of the height of the ADS. CONCLUSIONS AND RELEVANCE The ADS may be a useful method to diagnose keratoconus and keratoconus-suspect cases and serve as a grading and follow-up method for tracking disease severity.
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Affiliation(s)
- Arige Gideon Abou Said
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Einat Shneor
- Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
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A Hospital-Based Study on the Prevalence of Keratoconus in First-Degree Relatives of Patients with Keratoconus in Central China. J Ophthalmol 2022; 2022:6609531. [PMID: 35663517 PMCID: PMC9162836 DOI: 10.1155/2022/6609531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose The present study investigated the prevalence of keratoconus (KC) among first-degree relatives of KC patients in Central China. Methods From July 2018 to March 2022, 661 first-degree relatives of 384 KC patients were included in the present study. Corneal tomography, uncorrected distance visual acuity, manifest refraction with corrected distance visual acuity, intraocular pressure, slit-lamp microscopy, and fundus examination were performed. The diagnosis of KC was based on the Belin/Ambrosio enhanced ectasia total deviation value (BAD-D value) on the Pentacam® system (Oculus GmbH). BAD-D value <1.6 was diagnosed as healthy, 1.6≤ BAD-D value <2.6 was diagnosed as suspected KC, and BAD-D value ≥2.6 was diagnosed as KC. Results The present study included 337 (50.98%) female and 324 (49.02%) male subjects. The prevalence of KC and suspected KC in first-degree relatives was 8.77% (n = 58) and 29.05% (n = 192), respectively. The prevalence of KC was 9.70% among parents and 7.23% among siblings. Conclusions The higher prevalence of KC among first-degree relatives of patients with KC suggests that first-degree relatives of KC are at high risk of developing KC.
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Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 167] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
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Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Shneor E, Piñero DP, Doron R. Contrast sensitivity and higher-order aberrations in Keratoconus subjects. Sci Rep 2021; 11:12971. [PMID: 34155283 PMCID: PMC8217180 DOI: 10.1038/s41598-021-92396-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
This study analyzes the relationship between contrast-sensitivity and higher-order aberrations (HOA) in mild and subclinical-keratoconus in subjects with good visual-acuity (VA). Keratoconus group (including subclinical-keratoconus) and controls underwent autokeratometry, corneal-tomography, autorefraction and HOA measurement. Contrast-sensitivity was tested using a psychophysical two-alternative forced-choice Gabor patches in three blocks (6, 9, 12 cycles/deg). Controls were compared to the keratoconus group and to a keratoconus subgroup with VA of 0.00 LogMar group ("keratoconus-0.00VA"). Spearman correlation tested association between HOA and contrast-sensitivity. Twenty-two keratoconus subjects (38 eyes: 28 keratoconus, 10 subclinical-keratoconus, 20 keratoconus-0.00VA) and 35 controls were included. There was a significant difference between control and keratoconus, and between control and keratoconus-0.00VA, for keratometry, cylinder, thinnest and central corneal thickness (p < 0.001). Controls showed lower HOA and higher contrast-sensitivity for all spatial-frequencies (p < 0.001). Most HOA were negatively correlated with contrast-sensitivity for all spatial-frequencies for keratoconus group and for 9 and 12 cycles/deg for keratoconus-0.00VA. Keratoconus subjects with good VA showed reduction in contrast-sensitivity and increased HOAs compared to controls. HOA and contrast-sensitivity are inversely correlated in subjects with mild keratoconus despite good VA. This suggests that the main mechanism underlying the decreased vision quality in keratoconus is the increase of HOA.
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Affiliation(s)
- Einat Shneor
- Department of Optometry and Vision Science, Hadassah Academic College, Haniviim St. 37, 9101001, Jerusalem, Israel.
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Ravid Doron
- Department of Optometry and Vision Science, Hadassah Academic College, Haniviim St. 37, 9101001, Jerusalem, Israel
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13
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Chen S, Li XY, Jin JJ, Shen RJ, Mao JY, Cheng FF, Chen ZJ, Linardaki E, Voulgaraki S, Aslanides IM, Jin ZB. Genetic Screening Revealed Latent Keratoconus in Asymptomatic Individuals. Front Cell Dev Biol 2021; 9:650344. [PMID: 34136477 PMCID: PMC8202288 DOI: 10.3389/fcell.2021.650344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To adopt molecular screening in asymptomatic individuals at high risk of developing keratoconus as a combinative approach to prevent subclinical patients from post-refractive surgery progressive corneal ectasia. Methods In this study, 79 Chinese and nine Greek families with keratoconus were recruited, including 91 patients with clinically diagnosed keratoconus as well as their asymptomatic but assumptive high-risk first-degree relatives based on underlying genetic factor. Mutational screening of VSX1, TGFBI, and ZEB1 genes and full clinical assessment including Pentacam Scheimpflug tomography were carried out in these individuals. Results Five variants in VSX1 and TGFBI genes were identified in three Chinese families and one Greek family, and four of them were novel ones. Surprisingly, ultra-early corneal changes in Belin/Ambrosio Enhanced Ectasia Display of Pentacam corneal topography together with co-segregated variants were revealed in the relatives who had no self-reported symptoms. Conclusions Variants of VSX1 and TGFBI genes identified in both the clinically diagnosed and subclinical patients may cause the keratoconus through an autosomal dominant inheritance pattern, with different variable expressivity. Combining genetic with Belin/AmbrosioEnhanced Ectasia Display can be used to identify patients with latent keratoconus. This study indicates that genetic testing may play an important supplementary role in re-classifying the disease manifestation and evaluating the preoperative examination of refractive surgery.
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Affiliation(s)
- Shihao Chen
- Center for Refractive Surgery, The Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xing-Yong Li
- Center for Refractive Surgery, The Eye Hospital, Wenzhou Medical University, Wenzhou, China.,Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Jia-Jia Jin
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Ren-Juan Shen
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jian-Yang Mao
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Fei-Fei Cheng
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Zhen-Ji Chen
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | | | | | - Ioannis M Aslanides
- Center for Refractive Surgery, The Eye Hospital, Wenzhou Medical University, Wenzhou, China.,Emmetropia Mediterranean Eye Institute, Heraklion, Greece
| | - Zi-Bing Jin
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University and Capital Medical University, Beijing Tongren Hospital, Beijing, China
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Bykhovskaya Y, Rabinowitz YS. Update on the genetics of keratoconus. Exp Eye Res 2020; 202:108398. [PMID: 33316263 DOI: 10.1016/j.exer.2020.108398] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
In the past few years we have seen a great acceleration of discoveries in the field of keratoconus including new treatments, diagnostic tools, genomic and molecular determinants of disease risk. Recent genome-wide association studies (GWAS) of keratoconus cases and population wide studies of variation in central corneal thickness and in corneal biomechanical properties confirmed already identified genes and found many new susceptibility variants and biological pathways. Recent findings in genetic determinants of familial keratoconus revealed functionally important variants and established first mouse model of keratoconus. Latest transcriptomic and expression studies started assessing novel non-coding RNA targets in addition to identifying tissue specific effects of coding genes. First genomic insights into better prediction of treatment outcomes are bringing the advent of genomic medicine into keratoconus clinical practice.
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Affiliation(s)
- Yelena Bykhovskaya
- Cornea Genetic Eye Institute, Department of Surgery and Board of the Governors Regenerative Medicine Institute, Beverly Hills, Cedars-Sinai, Los Angeles, CA, United States.
| | - Yaron S Rabinowitz
- Cornea Genetic Eye Institute, Department of Surgery and Board of the Governors Regenerative Medicine Institute, Beverly Hills, Cedars-Sinai, Los Angeles, CA, United States
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Shneor E, Frucht‐Pery J, Granit E, Gordon‐Shaag A. The prevalence of corneal abnormalities in first-degree relatives of patients with keratoconus: a prospective case-control study. Ophthalmic Physiol Opt 2020; 40:442-451. [PMID: 32706487 PMCID: PMC7496242 DOI: 10.1111/opo.12706] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/20/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Although there is a high prevalence of keratoconus in the Middle East including Israel, limited data is available describing first-degree relatives of patients with sporadic keratoconus (KC) using Scheimpflug imaging. The purpose of this study is to accurately phenotype first-degree relatives of patients with sporadic KC in Israel using corneal tomography, which may help determine the genetic aetiology of KC. METHODS First-degree relatives (N = 56) of 16 KC probands participated in this prospective case-control study. Healthy controls (N = 96) were from a previous study. Autorefraction, visual acuity, slit lamp biomicroscopy, retinoscopy, subjective refraction and Scheimpflug imaging (CSO Sirius Topographer) of keratoconus patients and their first-degree relatives were evaluated. The worse eye was used for KC and KC suspects. The main outcome measure was prevalence of abnormal corneal topography and tomography parameters, which was compared between first-degree relatives vs controls. p values < 0.05 were considered significant. RESULTS KC (N = 2) or KC suspect (N = 8) was diagnosed in 18% (95% CI 8-28%) of the first-degree relatives. At least one abnormal corneal parameter was evident in 34% of first-degree relatives, while this was significantly lower for controls (14%, χ2(1,N = 152) = 8.8, p = 0.01). Qualitative analysis showed KC first-degree relatives had significantly more abnormal anterior corneal topography patterns than controls (34% vs 17%, χ2(1,N = 152) = 5.9, p = 0.02). For first-degree relatives, sex was not a factor influencing prevalence of corneal abnormalities (18% for both men and women, χ2(1,N = 56) = 0.0, p = 1.0). A significant correlation was found for first-degree relatives between age and most corneal parameters, while this was not evident for the control group. CONCLUSIONS AND RELEVANCE Eye care practitioners should consider first-degree relatives of patients with KC at moderate risk for the disease and/or corneal abnormalities.
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Affiliation(s)
- Einat Shneor
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
| | - Joseph Frucht‐Pery
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
| | - Edna Granit
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
| | - Ariela Gordon‐Shaag
- Department of Optometry and Vision ScienceHadassah Academic CollegeJerusalemIsrael
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