A Cross-sectional Analysis of Vision Related Quality of Life in Adult Patients With Keratoconus in Nairobi

Abstract

Background: Keratoconus is a mostly bilateral and asymmetric corneal ectasia, which presents with poor vision, blurred images and occasional eye pain. This may affect the patient’s quality of life by hindering participation in daily activities, experienced pain and ameliorated mental health. Justification: The study aimed to address the general gap in studies around keratoconus in Africa and specifically on vision related quality of life in adult patients with the disease. Objectives: Utilizing the NEI-VFQ-25 version 2000, the study aimed to determine self-reported VRQOL in adult patients with keratoconus in four eye care facilities in Nairobi. It also aimed established the relationship between the scores and age, sex and disease severity factors. Methods: The study design was a cross-sectional analytical and hospital-based study conducted in four facilities within Nairobi City County in Kenya that routinely treat patients with keratoconus. 86 participants all aged 18 years and above with a documented diagnosis of keratoconus based on either clinical or topographic/tomographic findings were recruited by consecutive sampling while attending the study sites for routine reviews, scheduled treatment or having received a recruitment message from a support group. Data was collected in a self-administered questionnaire and clinical details thereafter obtained from the patient’s file to facilitate grading of severity using the Amsler-Krumeich criteria. Results: The overall VRQOL composite score was found to be 68.3% with a standard deviation of 14.3. The composite score trend was better for female (p=0.0853), older than 30 years category (p=0.5057 ) and those with less severe grades of keratoconus (p=0.2599). There is significant better mental health for participants 30 years and above compared to younger categories (p=0.046) and better social functioning for those with bilateral keratoconus compared with those with unilateral keratoconus (p=0.005). Further trends showed that the composite VRQOL scores were worse for increasing average Mean K and decreasing mean thinnest corneal location for affected eye(s) (R2 = 0.0109 and R2 = 0.012 respectively). Conclusion: The study concluded that vision related quality of life in adult patients with keratoconus attending urban eye hospitals in Nairobi, Kenya was low, had comparable findings in other countries especially Saudi Arabia(24) but failed to surpass that of Iran(23) as hypothesized. Female participants, older patients in the cluster 30 years and above and those with less severe stage of keratoconus have better composite scores. However, age, sex, severity grades, average K-mean and average TCL for affected eye(s) and laterality are not statistically significant determinants of the VRQOL composite scores in adult patients with keratoconus. Recommendation: This study recommends the formation of adult keratoconus support groups targeting patients under 30 year, an emphasis psychological counselling during eye care for all patients with keratoconus and a similar study to capture the adolescents and patients aged below 18 years.