Assessing the risk factors of Keratoconus in Saudi Arabian population

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Saudi Digital Library
PURPOSE: The objective of this study is to gain a better understanding of the risk factors associated with the onset and progression of keratoconus in Saudi Arabia. The available research demonstrates that the Saudi Arabian culture (consanguineous marriage) and environment (arid climate) are potential risk factors for the occurrence of keratoconus. Studies also show that there is a higher prevalence of keratoconus in Saudi Arabia and Asia than other regions in the world. A better understanding of the risk factors associated with the onset and progression of keratoconus would be valuable for both eye care professionals and patients in Saudi Arabia. Such information may help patients with the disease and may even help prevent the disease in patients who may be at risk. METHODS: Patients seeking eye care at Qassim University eye clinic were included in the study. Participants were contacted through emails and by posting fliers in Qassim University campuses in Buraidah. Interested patients were contacted and scheduled for a for a screening to determine their eligibility for the study based on the inclusion and exclusion criteria. If eligible, they were given a full explanation of their involvement and role in the study and oral consent was obtained. A questionnaire was distributed to patients presenting to the eye clinics. The questionnaire included questions of demographic characteristics and potential risk factors. Participants were divided into two cases (with keratoconus) and control (without keratoconus but with other ocular problems). Keratoconus diagnosis of the participants were made by the attending optometrists or ophthalmologists. Multivariate logistic analyses were performed to identify the risk factors for keratoconus. Moreover, by performing logistic regression and CART analysis, supervised learning algorithms were developed to predict the likelihood of keratoconus based on the risk factors. RESULTS: There were 75 keratoconus patients and 75 control. Mean ages were 26.2 years (SD = ± 6.4) and 24.9 years (SD = ± 6.8) for the keratoconus patients and control participants, respectively. There was no statistically significant association between age and the incidence of Keratoconus (P = 0.35). Chi square test showed that there is a statistically significant association between gender and the keratoconus incidence (P < 0.05) with male being at higher risk. Eye rubbing behavior was present in a high percentage of participants in the keratoconus group (~ 97%), versus only 24 % of controls participants 3 (OR =0.301 and P <0.001). Univariate logistic regression showed that family history is statistically associated with the development of keratoconus and has the highest odds ratio OR = 5.07, P < 0.01, 95% CI (2.1 – 12.7). In addition, dryness is statistically associated with keratoconus, OR = 2.61, P < 0. 01, 95% CI (1.7 – 3.99). Although smoking has an odds ratio of 1.325, the association between smoking and keratoconus was not statistically significant, P = 0.5. Finally, gender was associated with development is keratoconus P = 0.005. However, the odds ratio was 0.301. The CART model to predict the chances of keratoconus occurrence has the accuracy of 73%. Our prediction model can be a baseline model for the future risk factor analysis studies that will be done in the middle eastern region. The models can be better trained by refining the risk factor quality and also by increasing keratoconus population in the study. Including clinical parameters in the prediction models would result in complex as well as model with better prediction accuracy. CONCLUSIONS: The study result supports the role of environmental changes and consanguineous marriage practice in the risk of keratoconus in Saudi Arabia. Further studies are demanded, with a large cohort of the population, to affirm the risk factors and the incidence characterist