Prevalence and Economic Burden of Keratoconus in the United States

center dot PURPOSE: To assess the prevalence and economic bur-den of keratoconus in the United States. center dot DESIGN: Retrospective cohort study. center dot METHODS: Patients enrolled in Medicaid and Chil-dren's Health Insurance Program (CHIP) who were di-agnosed with keratoconus between 2016 and 2019 were included. The data reported to the Centers for Disease Control and Prevention (CDC) Vision and Eye Health Surveillance System (VEHSS) were analyzed. The crude prevalence rates (national and statewise) were obtained from the database and extrapolated to estimate the kera-toconus case count in the United States. The keratoconus prevalence was compared between male and female indi-viduals using the Mann-Whitney test, whereas Brown-Forsythe 1-way analysis of variance was used to compare prevalence between age and racial groups. The Dunnett T3 multiple comparison test was used for intergroup com-parison. Finally, the economic burden of keratoconus was assessed by inflation-adjusted direct costs to patients and total cases in the country. center dot RESULTS: In the cohort of 69,502,000 patients enrolled for Medicaid and CHIP, the national prevalence of ker-atoconus was computed to be 0.04% in 2019 and had increased from 0.03% in 2016. The highest prevalence of keratoconus was observed in patients 18 to 39 years of age, followed by patients 40 to 64 years of age; compa-rable prevalence rates were observed in these age groups in the Black population. The prevalence was moderately higher in female compared to male individuals; however, significantly higher keratoconus prevalence was observed in Black female individuals compared to male individu-als. A significantly high prevalence of keratoconus was observed in the Black population, followed by Hispanic population. In 2019, the average inflation-adjusted life-time cost of keratoconus treatment was USD 28,766.69, with a cumulative economic burden of USD 3.8 billion. CONCLUSIONS: In the United States, keratoconus is most prevalent in individuals 18 to 39 years of age. The keratoconus prevalence is higher in the Black popula- tion, specifically female individuals, and the diagnosis is often delayed in these patients. (Am J Ophthalmol 2024;259: 71-78. (c) 2023 Elsevier Inc. All rights re- served.)