What is the current understanding of the prevalence, burden, and management of keratoconus in the Pacific Islands?

From the Guidelines

The current understanding of keratoconus in the Pacific Islands is severely limited due to a significant lack of epidemiological studies and regional data, with a likely substantial disease burden and limited access to specialized eye care services. The prevalence of keratoconus in this region is largely unknown, with no comprehensive population-based studies specifically examining its occurrence across Pacific Island nations, as noted in the study by 1. This knowledge gap presents a major challenge for healthcare planning and resource allocation.

Key Challenges

• Limited access to specialized eye care services in many Pacific Island communities, which may lead to delayed diagnosis and treatment
• Geographical isolation, limited healthcare infrastructure, and restricted access to advanced diagnostic equipment such as corneal topographers and tomographers
• Treatment options are presumably constrained, with corneal crosslinking (CXL) - the standard procedure to halt disease progression - likely available only in major urban centers if at all, as supported by the findings of 1 and 1

Management and Treatment

• Corneal cross-linking (CXL) is the recommended treatment for progressive keratoconus, as it stabilizes the cornea and reduces the risk of progressive ectasia, according to 1 and 1
• More advanced interventions such as intracorneal ring segments, specialized contact lenses, and corneal transplantation are probably even more limited
• The long-term stabilizing effect of CXL may be more cost-effective than corneal transplantation, as suggested by 1

Future Directions

• Targeted research is needed to better understand the prevalence and burden of keratoconus in the Pacific Islands
• Improved eye care infrastructure and training programs for local healthcare providers are essential to address the limited access to specialized eye care services in the region, as highlighted by the studies 1, 1, and 1

From the Research

Prevalence of Keratoconus in the Pacific Islands

• There is limited information available on the prevalence of keratoconus in the Pacific Islands specifically 2, 3, 4, 5.
• However, it is estimated that the global prevalence of keratoconus is between 1:375 to 1:2,000 people, with a higher rate in younger populations 4.
• The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities 5.

Burden of Keratoconus

• Keratoconus is a progressive disease that can lead to significant visual impairment and blindness if left untreated 2, 3, 4, 5.
• The disease can cause irregular astigmatism, corneal scarring, and even corneal perforation, resulting in decreased visual acuity and quality of life 2, 3, 4, 5.
• The economic burden of keratoconus is also significant, with costs associated with diagnosis, treatment, and management of the disease 3, 4.

Management of Keratoconus

• Early detection and screening of keratoconus are essential for effective management and treatment 2, 3, 4, 5.
• Several screening methods, such as corneal topography and tomography, corneal biomechanics, and genetic testing, are being developed to detect keratoconus at an early stage 2, 3, 4, 5.
• Treatment options for keratoconus include corneal collagen cross-linking, scleral lenses, intracorneal ring segments, corneal allogenic intrastromal ring segments, and deep anterior lamellar keratoplasty 2, 3, 4, 5, 6.
• The choice of treatment depends on the severity and progression of the disease, as well as the individual patient's needs and preferences 3, 4, 5, 6.