2025 - 3 Issue

Original article

Evaluating the Influence of Eye Rubbing and Genetic Predisposition on Keratoconus in Bucaramanga (Colombia): A Case-control Study

Laura María Duarte-Bueno ORCID
Alejandro Tello ORCID – Luis Alfonso Diaz-Martínez ORCID – Sergio Escobar ORCID – Virgilio Galvis ORCID

Full Text links

DOI: 10.31348/2025/2

Published in Czech and Slovak Ophtalmology: 2025 - 3

Published on website: 20.01.2025

Keywords: keratoconus, risk factors, case-control studies, Latin America

Summary

Aim: To determine risk factors associated with keratoconus in Bucaramanga, Colombia.

Material and Methods: A paired case-control study was conducted at Bucaramanga, Colombia, between November 2022 and December 2023. The controls were age- and sex-matched. Patients answered a questionnaire designed for this study regarding their family history of keratoconus, eye rubbing, atopy, sun exposure, and sleeping habits. Information from medical records was also obtained. Univariate and multivariate conditional analyses were used to test the significance of associations.

Results: One hundred fifty-six patients with a diagnosis of keratoconus and 312 controls were included. Univariate analyses revealed significant differences between cases and controls in the following factors: very frequent eye rubbing (OR = 20.9, 95% CI 6.2–70.1), a positive family history of keratoconus (OR = 13.0, 95% CI 5.5–30.8), a personal history of atopy (OR = 2.2), and nocturnal eye compression (OR = 1.7, 95% CI 1.0–2.7). Multivariate analysis showed a statistical significance for eye rubbing (OR = 6.9, 95% CI 3.8–12.5), and family history of keratoconus (OR = 10.3, 95% CI 2.3–44.9). There was a significant mild interaction between both, since when the two coincided the OR increased up to 74.1 times.

Conclusion: Eye rubbing and family history of keratoconus were the most important risk factors for keratoconus in our population. Although it is impossible to establish causal relationships, our results suggest that controlling eye rubbing could be a potentially useful preventive measure, particularly in individuals with a family history of keratoconus. Other factors, such as sun exposure, sleeping position, and atopy, may play a role in the pathophysiology of the disease.

References

  1. Rabinowitz YS, Galvis V, Tello A, Rueda D, García JD. Genetics vs chronic corneal mechanical trauma in the etiology of keratoconus. Exp Eye Res. 2021;202:1-8.
  2. Naderan M, Shoar S, Rezagholizadeh F, Zolfaghari M, Naderan M. Characteristics and associations of keratoconus patients. Contact Lens Anterior Eye [Internet]. 2015;38(3):199-205. Available from: http://dx.doi.org/10.1016/j.clae.2015.01.008
  3. Shneor E, Millodot M, Gordon-Shaag A et al. Prevalence of Keratoconus among Young Arab students in Israel. Int J Keratoconus Ectatic Corneal Dis. 2014;3(1):9-14.
  4. Gordon MO, Steger-May K, Szczotka-Flynn L, et al. Baseline Factors Predictive of Incident Penetrating Keratoplasty in Keratoconus. Am J Ophthalmol. 2006;142(6):923-930.
  5. Gorskova E, Sevostianov E. Epidemiology of keratoconus in the Ural. Vestn Oftalmol. 1998;114:38-40.
  6. Torres Netto EA, Al-Otaibi WM, Hafezi NL et al. Prevalence of keratoconus in paediatric patients in Riyadh, Saudi Arabia. Br J Ophthalmol. 2018;102(10):1436-1441.
  7. Santodomingo-Rubido J, Carracedo G, Suzaki A et al. Keratoconus: An updated review. Cont Lens Anterior Eye. 2022;45(3):101559. doi: 10.1016/j.clae.2021.101559
  8. Galvis V, Tello A, Jaramillo JA et al. Prevalencia de queratocono en pacientes que consultaron con deseos de cirugía refractiva en un centro oftalmológico de referencia de Bucaramanga, Colombia. [Prevalence of keratoconus patients who consulted with a desire refractive surgery in ophthalmology center reference Bucaramanga, Colombia]. Rev Soc Colomb Oftalmol. 2011;44(2):129-134. Spanish.
  9. Barraquer Coll C, Barrera Rodríguez RE, Molano González N. Prevalencia de pacientes con queratocono en la Clínica Barraquer en Bogotá, Colombia. [Prevalence of keratoconus patients at the Barraquer Clinic in Bogotá, Colombia]. Rev Soc Colomb Oftalmol. 2020;53(1):17-23.
  10. Mejia-Salgado G, Cifuentes-González C, Rojas-Carabali W, et al. Colombian Ocular Diseases Epidemiology Study (CODES): Incidence and sociodemographic characterisation of keratoconus between 2015 and 2020. BMJ Open Ophthalmol. 2023;8(1):1-9.
  11. Galvis V, Sherwin T, Tello A et al. Keratoconus: An inflammatory disorder? Eye. 2015;29(7):843-859.
  12. Hashemi H, Heydarian S, Hooshmand E, Saatchi M, Yekta A, Aghamirsalim M, et al. The Prevalence and Risk Factors for Keratoconus: A Systematic Review and Meta-Analysis. Cornea. 2020;39(2):263-270.
  13. Crawford AZ, Zhang J, Gokul A, McGhee CNJ, Ormonde SE. The enigma of environmental factors in keratoconus. Asia-Pacific J Ophthalmol. 2020;9(6):549-556.
  14. Gatinel D, Galvis V, Tello A et al. Obstructive Sleep Apnea-Hypopnea Syndrome and Keratoconus: An Epiphenomenon Related to Sleep Position? Cornea. 2020;39(4):e11-e12.
  15. Moran S, Gomez L, Zuber K, Gatinel D. A Case-Control Study of Keratoconus Risk Factors. Cornea. 2020;39(6):697-701.
  16. Mazharian A, Panthier C, Courtin R et al. Incorrect sleeping position and eye rubbing in patients with unilateral or highly asymmetric keratoconus: a case-control study. Graefe’s Arch Clin Exp Ophthalmol. 2020;258(11):2431-2439.
  17. Gordon-Shaag A, Millodot M, Kaiserman I et al. Risk factors for keratoconus in Israel: A case-control study. Ophthalmic Physiol Opt. 2015;35(6):673-681.
  18. Mazharian A, Flamant R, Elahi S et al. Medium to long term follow up study of the efficacy of cessation of eye-rubbing to halt progression of keratoconus. Front Med. 2023;10:1152266. doi: 10.3389/fmed.2023.1152266
  19. Shetty R, Rao H, Khamar P et al. Keratoconus Screening Indices and Their Diagnostic Ability to Distinguish Normal From Ectatic Corneas. Am J Ophthalmol [Internet]. 2017;181:140-148. Available from: http://dx.doi.org/10.1016/j.ajo.2017.06.031
  20. Gordon-Shaag A, Millodot M, Essa M et al. Is consanguinity a risk factor for keratoconus? Optom Vis Sci. 2013;90(5):448-454.
  21. Almusawi LA, Hamied FM. Risk factors for development of keratoconus: A matched pair case-control study. Clin Ophthalmol. 2021;15:3473-3479.
  22. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform [Internet]. 2009;42(2):377-381. Available from: http://dx.doi.org/10.1016/j.jbi.2008.08.010
  23. Bawazeer AM, Hodge WG, Lorimer B, Rapuano CJ. Atopy and keratonus: A multivariate analysis. Evidence-Based Eye Care. 2001;2(2):84-85.
  24. Gatinel D. Eye Rubbing, a Sine Qua Non for Keratoconus? Int J Keratoconus Ectatic Corneal Dis. 2016;5(1):6-12.
  25. Hashemi H, Khabazkhoob M, Yazdani N et al. The prevalence of keratoconus in a young population in Mashhad, Iran. Ophthalmic Physiol Opt. 2014;34(5):519-527.
  26. Millodot M, Shneor E, Albou S, Atlani E, Gordon-Shaag A. Prevalence and associated factors of keratoconus in jerusalem: A cross-sectional study. Ophthalmic Epidemiol. 2011;18(2):91-97.
  27. Gatinel D. Challenging the “No Rub, No Cone” Keratoconus Conjecture. Int J Keratoconus Ectatic Corneal Dis. 2018;7(1):66-81.
  28. Bykhovskaya Y, Rabinowitz YS. Update on the genetics of keratoconus. Exp Eye Res [Internet]. 2021;202:108398. Available from: https://doi.org/10.1016/j.exer.2020.108398
  29. Lin KK, Lee JS, Hou CH et al. The Sociodemographic and Risk Factors for Keratoconus: Nationwide Matched Case-Control Study in Taiwan, 1998-2015. Am J Ophthalmol [Internet]. 2021;223:140-
  30. Woodward MA, Blachley TS, Stein JD. The association between sociodemographic factors, common systemic diseases, and keratoconus an analysis of a nationwide heath care claims database. Ophthalmology. 2016;123(3):457-465.
  31. Lee HK, Jung EH, Cho BJ. Epidemiological Association Between Systemic Diseases and Keratoconus in a Korean Population: A 10-Year Nationwide Cohort Study. Cornea. 2020;39(3):348-
  32. Johansson SGO, Bieber T, Dahl R et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October2003. J Allergy Clin Immunol. 2004;113(5):832-836.
  33. Gordon-Shaag A, Millodot M, Shneor E, Liu Y. The genetic and environmental factors for keratoconus. Biomed Res Int. 2015;2015:795738.
  34. Ahmad TR, Kong AW, Turner ML et al. Socioeconomic Correlates of Keratoconus Severity and Progression. Cornea. 2023;42(1):60-65.
  35. Tello A, Gatinel D, Galvis V et al. Letter Regarding: Socioeconomic Correlates of Keratoconus Severity and Progression. Cornea. 2023;42(6):E9.
  36. Bitton K, Dubois M, Moran S, Gatinel D. Discordant Keratoconus in Monozygotic Twins. Case Rep Ophthalmol. 2022;13(1):313-317.
  37. Available from: https://doi.org/10.1016/j.ajo.2020.09.040