COMMENTARY

The Absence of Older Keratoconus Patients

Christopher J. Rapuano, MD

Disclosures

June 24, 2013

Quo Vadis, Older Keratoconus Patients? Do They Die at Younger Ages?

McMonnies CW
Cornea. 2013:32:496-502

Study Summary

In this review article, the author attempted to address the question of why there seems to be a lack of older patients with keratoconus in many eye care practices. He performed a 2-pronged study: (1) a literature review of the epidemiology of keratoconus and the potentially hazardous conditions associated with keratoconus, and (2) a survey of specialized contact lens-fitting practitioners regarding the ages of keratoconus and nonkeratoconus patients in their practices.

The author found that the literature mostly demonstrated a relatively younger mean age for keratoconus patients, with a lower percentage older than 50 years compared with other patients. The literature also described numerous conditions associated with keratoconus that could affect life expectancy, including Down syndrome, Ehlers-Danlos syndrome, mitral valve prolapse, obesity, obstructive sleep apnea/hypopnea syndrome, floppy eyelid disease, and atopic disease. Of the original 18 private practices that were invited to contribute data, 10 ended up doing so. When keratoconus patients and nonkeratoconus patients older than 80 years and 90 years were compared, there were many fewer patients than expected in the keratoconus group (about one sixth of the entire study sample) (P < .001).

The author offered several possible explanations for the phenomenon of not seeing as many older patients with keratoconus as expected, including gender bias: More patients with keratoconus are men, and they have a shorter life expectancy than women in most countries. He concluded that there is "no clear evidence" that these conditions contribute to decreased life expectancy in patients with keratoconus, although the possibility cannot be ruled out.

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