Prevalence of Keratoconus is 10x Higher Than Previously Thought

Prevalence of Keratoconus is 10x Higher Than Previously Thought

In optometry school, I was taught that keratoconus was a relatively uncommon corneal disease process affecting approximately 1 in every 2,000 individuals. This statistic, from 1986, is being called into question by a recent German study investigating the current prevalence of keratoconus and its possible associated factors.

The study, which focused on the prevalence of keratoconus in a predominantly Caucasian population, found that keratoconus is approximately 10 times higher than what is commonly reported in the literature. This new research was completed using Scheimpflug imaging as opposed to previous research, which used a more antiquated version of corneal mapping (solely topography).

Of the 10,419 patients involved in the study, 0.49% had keratoconus, which puts the actual prevalence at approximately 1 in every 200 members of the Caucasian population. Interestingly, and contrary to previous assumptions, the study found no connections with sex, existing atopy, diabetes, smoking, depression, or thyroid dysfunction. A logistic regression also showed no association between keratoconus and a patient's age, sex, BMI, thyroid hormone, arterial hypertension, steroid use, allergy, sleep apnea, smoking, diabetes, atopy, depression, or asthma.

OUTSIDE THE LANE

AI-Supported Mammography Screening Safe, Accurate, and Efficient

An interim safety analysis of the first randomized, controlled trial of its kind involving more than 80,000 Swedish women found that artificial intelligence (AI)-supported mammography analysis is as good as two breast radiologists working together to detect breast cancer, almost halving the screen-reading workload without increasing false positives.

Between April 2021 and July 2022, women 40 to 80 years of age who had undergone mammogram screening at four sites in southwest Sweden were randomly assigned in a 1:1 ratio to either an AI-supported analysis or a standard analysis performed by two radiologists without AI (control arm). AI-supported screening detected 20% more cancers compared with the routine double reading of mammograms by two breast radiologists. Additionally, the use of AI did not increase false positives and reduced the mammogram reading workload by 44%.

“The greatest potential of AI right now is that it could allow radiologists to be less burdened by the excessive amount of reading,” says lead author Kristina Lång, MD, PhD.

AI-supported mammography screening resulted in a similar cancer detection rate compared with standard double reading, with a substantially lower screen reading workload, which indicates that the use of AI in mammography screening is safe.

The final trial results looked at whether the use of AI in interpreting mammography images translates into a reduction in interval cancers (cancers detected between screenings that generally have a poorer prognosis than screen-detected cancers) in 100,000 women followed over 2 years—and ultimately whether AI’s use in mammography screening is justified—are not expected for several years.

My Two Cents

This sounds a lot like AI in retinal imagining reading, doesn’t it? As AI technology advances, it’s important to remember that it can offer the public the absolute best care when combined with a trained medical professional. Rather than fearing it, let’s embrace it and use it to help us be the best practitioners we can be.

CAN YOU RELATE

One of the things I love about my practice is that there are always other doctors around whom I can brainstorm with and go to when I’m unsure about something. Recently, I was in the clinic with one of our more seasoned clinicians (he’s in his early 70s), while I was seeing another one of our doctor’s follow-ups who had allergic conjunctivitis and an external hordeolum. 

The patient had been seen twice previously over the past 10 days and reported worsening symptoms with the use of an OTC antihistamine drop and oral cefalexin. When I examined the patient behind the slit lamp, I noted the trace superficial punctate keratitis that was in the record since the first visit, as well as ever-increasing lid swelling. The keratitis could also be viewed as tiny dendrites with a little imagination added, so I decided to use my “phone a friend” and call the other doctor into the room to get his opinion.

When the other doctor took a peek at the patient, he said to me, “Well bud, I’m not entirely sure if those things are dendrites or not, but when in doubt, hit them with an oral antiviral.” He then reminded me of the mechanism of action of an oral antiviral and emphasized how quickly they are processed by most bodies. He added, “I’ve been doing this for more years than you’ve been alive—trust me.”

One week later, the patient showed up with a fully resolved cornea and orbital area appearance. The old guy was right once again! What’s better than on-demand advice? What do those of you in solo practices do in similar situations? Literally phone a friend?

QUOTE OF THE WEEK

“The only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle.”

— Steve Jobs