Clinical and demographic profile of patients with keratoconus in the Eastern Cape, South Africa

Abstract

Background Keratoconus (KC) is a progressive corneal ectasia and a leading indication for corneal transplantation in South Africa. While prevalence data exist for other provinces, there is a paucity of literature describing the disorder profile in the Eastern Cape, a region characterised by unique socio-economic challenges and limited access to specialists. Methods A retrospective chart review was conducted on 131 patients (262 eyes) diagnosed with KC at a specialist corneal practice in Gqeberha between September 2019 and September 2020. Demographics, visual acuity, KC severity and management markers were assessed using Galilei G6 tomography and clinical records. Results The median age at assessment was 29 years (interquartile range: 21.5–40.0), with 62.6% of patients aged under 35 years. The cohort was racially diverse, comprising 41.22% black people, 38.17% white people, 14.50% people of mixed race and 6.11% Indian people. Mild and moderately severe disease was most common in both eyes, representing 64.12% of left eyes and 58.78% of right eyes. Severity was greater in the left eye and significantly associated with eye rubbing (p = 0.042). In all, 53.44% of patients were female. Corneal collagen cross-linking was recommended in 31.30% of left eyes, and 25.95% of patients qualified for keratoplasty. Conclusion Patients in the Eastern Cape present with advanced KC at a young age. The high burden of severe pathology necessitates aggressive early detection and treatment strategies. Contribution These findings support the need for screening and improved access to progression-halting and optical rehabilitation services to prevent reversible blindness in this economically active population.