Quality of life in keratoconus patients in a tertiary hospital in Thailand.
Main Article Content
Abstract
Background: Keratoconus is a progressive corneal ectatic disease that significantly impacts visual function and quality of life (QoL) in affected individuals.
Objective: This primary objective of this study aimed to evaluate the QoL of keratoconus patients in Thammasat University Hospital and compare it with a control group. The secondary objective was a subgroup analysis aimed to compare the QoL between keratoconus patients who underwent collagen cross-linking (CXL) with those who received supportive treatment. The study was conducted at Thammasat University Hospital, Pathumthani Province, Thailand.
Methods: Keratoconus patients were recruited from Thammasat University Hospital by random sampling. Control patients were recruited by
consent at the General Practice Outpatient Department. The Thai version of the National Eye Institute of Visual Functioning Questionnaire (T-NEI-VFQ-25) was used to assess quality of life in both groups. The questionnaire had 25 items grouped into seven categories related to quality of life. For every response, choices of worded answers were converted into integer scores ranging 1 to 5 associated with the lowest to highest quality of life respectively. Two-sample two-tailed t-test was used to determine statistical significance at alpha = 0.05.
Results: The results showed that all QoL domains were negatively impacted in keratoconus patients, with the most significant compromise observed in mental health (mean score = 3.961, s.d. = 0.711). The least disrupted component were social aspects (mean score = 4.597, s.d. = 0.382). The domain with the greatest difference between keratoconus and control were social aspects (p = 0.00000420). Subgroup analysis revealed no statistically significant difference between the two groups of keratoconus patients regarding QoL, though the CXL group reported lower scores in mental health (mean score of 4.175 versus 3.733, s.d. 0.903 versus 0.827, p = 0.000162). Those who underwent CXL had better scores in ocular symptoms, activities of daily living and transportation.
Conclusions: These findings suggest that keratoconus affects various aspects of QoL, with mental health being a key concern. The study underscores the importance of integrating QoL assessments into clinical management to tailor treatments, including the consideration of mental health in treatment plans. Further research is needed to explore the long-term effects of collagen cross-linking and other surgical treatments on QoL in keratoconus patients.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Agrawal, V. (2013). Long-term results of cornea collagen cross-linking with riboflavin for keratoconus. Indian J Ophthalmol, 61(8), 433-434. https://doi.org/10.4103/0301-4738.116072
Al Zabadi, H., Shehadeh, M., Amro, L., Ghattass, N., & Taha, I. (2023). Vision-related quality of life among patients with keratoconus: a cross sectional study [Original Research]. Frontiers in Medicine, 10. https://doi.org/10.3389/fmed.2023.1208911
Fournié, P., Acquadro, M., Touboul, D., Cochener, B., Chiambaretta, F., Muraine, M., Borderie, V., Bourges, J.-L., Benmedjahed, K., Tugaut, B., Bernheim, D., Bourcier, T., Burillon, C., David, T., Delbosc, B., Gain, P., Hoffart, L., Labetoulle, M., Laroche, L.,…Arnould, B. (2023). Keratoconus and the Impact of Treatment on Patients’ Quality of Life: A Qualitative Study. Ophthalmology and Therapy, 12(4), 1939-1956. https://doi.org/10.1007/s40123-023-00717-w
Gomes, J. A., Tan, D., Rapuano, C. J., Belin, M. W., Ambrósio, R., Jr., Guell, J. L., Malecaze, F., Nishida, K., & Sangwan, V. S. (2015). Global consensus on keratoconus and ectatic diseases. Cornea, 34(4), 359-369. https://doi.org/10.1097/ico.0000000000000408
Gomes, J. A. P., Rodrigues, P. F., & Lamazales, L. L. (2022). Keratoconus epidemiology: A review. Saudi J Ophthalmol, 36(1), 3-6. https://doi.org/10.4103/sjopt.sjopt_204_21
Mahikul, W., Srichan, P., Narkkul, U., Soontarawirat, I., Kitro, A., Pumipuntu, N., Saita, S., & Narayam, P. (2024). Mental health status and quality of life among Thai people after the COVID-19 outbreak: a cross-sectional study. Scientific Reports, 14(1), 25896. https://doi.org/10.1038/s41598-024-77077-3
Mangione, C. M., Lee, P. P., Gutierrez, P. R., Spritzer, K., Berry, S., & Hays, R. D. (2001). Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol, 119(7), 1050-1058. https://doi.org/10.1001/archopht.119.7.1050
Munir, S. Z., Munir, W. M., & Albrecht, J. (2021). Estimated Prevalence of Keratoconus in the United States From a Large Vision Insurance Database. Eye Contact Lens, 47(9), 505-510. https://doi.org/10.1097/icl.0000000000000812
Piyacomn, Y., Kasetsuwan, N., Puangsricharern, V., Reinprayoon, U., Satitpitakul, V., & Chantaren, P. (2022). Keratoconus in Thai population - a cross-sectional hospital-based study. Asian Biomed (Res Rev News), 16(6), 316-321. https://doi.org/10.1515/abm-2022-0035
Setthawatcharawanich, S., Aui-aree, N., Sathirapanya, P., Phabphal, K., & Limapichat, K. (2009). Validation of a Disease-Specific Questionnaire for Health-Related Quality of Life in Thai. Journal of Health Science and Medical Research (JHSMR), 27.
Suñer, I. J., Kokame, G. T., Yu, E., Ward, J., Dolan, C., & Bressler, N. M. (2009). Responsiveness of NEI VFQ-25 to Changes in Visual Acuity in Neovascular AMD: Validation Studies from Two Phase 3 Clinical Trials. Investigative Ophthalmology & Visual Science, 50(8), 3629-3635. https://doi.org/10.1167/iovs.08-3225
Sykakis, E., Karim, R., Evans, J. R., Bunce, C., Amissah‐Arthur, K. N., Patwary, S., McDonnell, P. J., & Hamada, S. (2015). Corneal collagen cross‐linking for treating keratoconus. Cochrane Database of Systematic Reviews(3). https://doi.org/10.1002/14651858.CD010621.pub2
