Personalized Model to Predict Keratoconus Progression From Demographic, Topographic, and Genetic Data

被引：11

作者：

Maile, Howard p. ^{[1
]}

LI, Ji-peng olivia ^{[2
]}

Fortune, Mary d. ^{[3
]}

Royston, Patrick ^{[4
]}

Leucci, Marcello t. ^{[2
]}

Moghul, Ismail ^{[1
]}

Szabo, Anita ^{[1
]}

Balaskas, Konstantinos ^{[2
]}

Allan, Bruce d. ^{[2
]}

Hardcastle, Alison j. ^{[1
]}

Hysi, Pirro ^{[5
,6
]}

Pontikos, Nikolas ^{[1
]}

Tuft, Stephen j. ^{[2
]}

Gore, Daniel m. ^{[2
,7
]}

机构：

[1] UCL, Inst Ophthalmol, London, England

[2] Moorfields Eye Hosp, NHS Fdn Trust, London, England

[3] Univ Cambridge, Cambridge Inst Publ Hlth, MRC Biostat Unit, Cambridge, England

[4] MRC Clin Trials Unit UCL, London, England

[5] Kings Coll London, Sch Life Course Sci, Sect Ophthalmol, London, England

[6] Kings Coll London, Dept Twin Res & Genet Epidemi ol, London, England

[7] Moorfields Eye Hosp, London, England

来源：

AMERICAN JOURNAL OF OPHTHALMOLOGY | 2022年 / 240卷

关键词：

COLLAGEN CROSS-LINKING; COST-EFFECTIVENESS; ETHNIC-ORIGIN; PENTACAM HR;

D O I：

10.1016/j.ajo.2022.04.004

中图分类号：

R77 [眼科学];

学科分类号：

100212 ;

摘要：

PURPOSE: To generate a prognostic model to predict keratoconus progression to corneal crosslinking (CXL). DESIGN: Retrospective cohort study. METHODS: We recruited 5025 patients (9341 eyes) with early keratoconus between January 2011 and November 2020. Genetic data from 926 patients were available. We investigated both keratometry or CXL as end points for progression and used the Royston-Parmar method on the proportional hazards scale to generate a prognostic model. We calculated hazard ratios (HRs) for each significant covariate, with explained variation and discrimination, and performed internal-external cross validation by geographic regions. RESULTS: After exclusions, model fitting comprised 8701 eyes, of which 3232 underwent CXL. For early keratoconus, CXL provided a more robust prognostic model than keratometric progression. The final model explained 33% of the variation in time to event: age HR (95% CI) 0.9 (0.90-0.91), maximum anterior keratometry 1.08 (1.07-1.09), and minimum corneal thickness 0.95 (0.930.96) as significant covariates. Single-nucleotide polymorphisms (SNPs) associated with keratoconus (n = 28) did not significantly contribute to the model. The predicted time-to-event curves closely followed the observed curves during internal-external validation. Differences in discrimination between geographic regions was low, suggesting the model maintained its predictive ability. CONCLUSIONS: A prognostic model to predict keratoconus progression could aid patient empowerment, triage, and service provision. Age at presentation is the most significant predictor of progression risk. Candidate SNPs associated with keratoconus do not contribute to progression risk.

引用

页码：321 / 329

页数：9

共 32 条

[21] Belin ABCD Progression Display Identifies Keratoconus Progression Earlier Than Conventional Metrics [J].