Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies
Abstract This report explores the prevalence of keratoconus in a population-based cohort of adults aged 40 or older according to ten different definitions. All Rotterdam Study participants with reliable Pentacam scans and no prior corneal refractive surgery were cross-sectionally analysed (n = 2660)...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-01-01
|
| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-025-87532-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832571703870357504 |
|---|---|
| author | Hasan Shabani Bart T. H. van Dooren Magda A. Meester-Smoor Annette A. J. M. Geerards Caroline C. W. Klaver Wishal D. Ramdas |
| author_facet | Hasan Shabani Bart T. H. van Dooren Magda A. Meester-Smoor Annette A. J. M. Geerards Caroline C. W. Klaver Wishal D. Ramdas |
| author_sort | Hasan Shabani |
| collection | DOAJ |
| description | Abstract This report explores the prevalence of keratoconus in a population-based cohort of adults aged 40 or older according to ten different definitions. All Rotterdam Study participants with reliable Pentacam scans and no prior corneal refractive surgery were cross-sectionally analysed (n = 2660). First, we applied a novel evidence-based definition. Suspected keratoconus was defined as having at least one eye with a final D-index (BAD-D) ≥ 2.6. Manifest keratoconus was defined as having at least one eye with: (1) BAD-D ≥ 2.6; and (2) a score of at least 4/10 on the novel Rotterdam Keratoconus Scale (RKS); and (3) a confirming assessment of the relevant Pentacam maps; and (4) meeting Holladay’s criteria in case of recent contact lens usage. Using this proposed definition, 72 participants (2.71%, 95%CI: 2.16–3.40%) had suspected keratoconus, while 10 participants (0.38%, 95%CI: 0.20–0.69%) had manifest keratoconus. To assess reproducibility, two specialists independently applied the proposed definition, with a substantial inter-observer agreement (Kappa = 0.74). Interestingly, 6(60%) patients were unaware of having keratoconus. Applying nine alternative definitions from similar screening studies produced prevalence estimates ranging from 0.19 to 9.29% in the same cohort. Moreover, counting solely on a BAD-D cutoff of 2.6 to define keratoconus was unreliable, with a low positive predictive value of 14%. These findings explain partially the large heterogeneity in the reported keratoconus prevalences, underscoring the need for a standardized definition. |
| format | Article |
| id | doaj-art-13bc099c80f1430cae16c515ef1bf539 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-13bc099c80f1430cae16c515ef1bf5392025-02-02T12:22:12ZengNature PortfolioScientific Reports2045-23222025-01-0115111010.1038/s41598-025-87532-4Different keratoconus definitions can lead to substantial prevalence disparities in population-based studiesHasan Shabani0Bart T. H. van Dooren1Magda A. Meester-Smoor2Annette A. J. M. Geerards3Caroline C. W. Klaver4Wishal D. Ramdas5Department of Ophthalmology, Erasmus Medical CentreDepartment of Ophthalmology, Erasmus Medical CentreDepartment of Ophthalmology, Erasmus Medical CentreCornea Centre, The Rotterdam Eye HospitalDepartment of Ophthalmology, Erasmus Medical CentreDepartment of Ophthalmology, Erasmus Medical CentreAbstract This report explores the prevalence of keratoconus in a population-based cohort of adults aged 40 or older according to ten different definitions. All Rotterdam Study participants with reliable Pentacam scans and no prior corneal refractive surgery were cross-sectionally analysed (n = 2660). First, we applied a novel evidence-based definition. Suspected keratoconus was defined as having at least one eye with a final D-index (BAD-D) ≥ 2.6. Manifest keratoconus was defined as having at least one eye with: (1) BAD-D ≥ 2.6; and (2) a score of at least 4/10 on the novel Rotterdam Keratoconus Scale (RKS); and (3) a confirming assessment of the relevant Pentacam maps; and (4) meeting Holladay’s criteria in case of recent contact lens usage. Using this proposed definition, 72 participants (2.71%, 95%CI: 2.16–3.40%) had suspected keratoconus, while 10 participants (0.38%, 95%CI: 0.20–0.69%) had manifest keratoconus. To assess reproducibility, two specialists independently applied the proposed definition, with a substantial inter-observer agreement (Kappa = 0.74). Interestingly, 6(60%) patients were unaware of having keratoconus. Applying nine alternative definitions from similar screening studies produced prevalence estimates ranging from 0.19 to 9.29% in the same cohort. Moreover, counting solely on a BAD-D cutoff of 2.6 to define keratoconus was unreliable, with a low positive predictive value of 14%. These findings explain partially the large heterogeneity in the reported keratoconus prevalences, underscoring the need for a standardized definition.https://doi.org/10.1038/s41598-025-87532-4 |
| spellingShingle | Hasan Shabani Bart T. H. van Dooren Magda A. Meester-Smoor Annette A. J. M. Geerards Caroline C. W. Klaver Wishal D. Ramdas Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies Scientific Reports |
| title | Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies |
| title_full | Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies |
| title_fullStr | Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies |
| title_full_unstemmed | Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies |
| title_short | Different keratoconus definitions can lead to substantial prevalence disparities in population-based studies |
| title_sort | different keratoconus definitions can lead to substantial prevalence disparities in population based studies |
| url | https://doi.org/10.1038/s41598-025-87532-4 |
| work_keys_str_mv | AT hasanshabani differentkeratoconusdefinitionscanleadtosubstantialprevalencedisparitiesinpopulationbasedstudies AT bartthvandooren differentkeratoconusdefinitionscanleadtosubstantialprevalencedisparitiesinpopulationbasedstudies AT magdaameestersmoor differentkeratoconusdefinitionscanleadtosubstantialprevalencedisparitiesinpopulationbasedstudies AT annetteajmgeerards differentkeratoconusdefinitionscanleadtosubstantialprevalencedisparitiesinpopulationbasedstudies AT carolinecwklaver differentkeratoconusdefinitionscanleadtosubstantialprevalencedisparitiesinpopulationbasedstudies AT wishaldramdas differentkeratoconusdefinitionscanleadtosubstantialprevalencedisparitiesinpopulationbasedstudies |