Clinical and demographic profile of patients with keratoconus in the Eastern Cape, South Africa

Abstract

Background: Keratoconus (KC) is a progressive corneal ectasia and a leading indication for corneal transplantation in South Africa. While prevalence data exist for other provinces, there is a paucity of literature describing the disorder profile in the Eastern Cape, a region characterised by unique socio-economic challenges and limited access to specialists.
Methods: A retrospective chart review was conducted on 131 patients (262 eyes) diagnosed with KC at a specialist corneal practice in Gqeberha between September 2019 and September 2020. Demographics, visual acuity, KC severity and management markers were assessed using Galilei G6 tomography and clinical records.
Results: The median age at assessment was 29 years (interquartile range: 21.5–40.0), with 62.6% of patients aged under 35 years. The cohort was racially diverse, comprising 41.22% black people, 38.17% white people, 14.50% people of mixed race and 6.11% Indian people. Mild and moderately severe disease was most common in both eyes, representing 64.12% of left eyes and 58.78% of right eyes. Severity was greater in the left eye and significantly associated with eye rubbing (p = 0.042). In all, 53.44% of patients were female. Corneal collagen cross-linking was recommended in 31.30% of left eyes, and 25.95% of patients qualified for keratoplasty.
Conclusion: Patients in the Eastern Cape present with advanced KC at a young age. The high burden of severe pathology necessitates aggressive early detection and treatment strategies.
Contribution: These findings support the need for screening and improved access to progression-halting and optical rehabilitation services to prevent reversible blindness in this economically active population.