Demographic and clinical presentations of keratoconus in Trinidad and Tobago: a retrospective study

Abstract

Keratoconus is a progressive corneal disorder characterised by thinning and protrusion of the cornea, leading to irregular astigmatism and visual impairment. Data describing the demographic and clinical profiles of Caribbean populations are limited. This study evaluated the demographic and clinical characteristics of keratoconus among patients in Trinidad and Tobago. Method A retrospective chart review was conducted among patients diagnosed with keratoconus who attended the University of the West Indies Optometry Clinic in Trinidad and Tobago between January 2010 and December 2022. Data collected included demographics, clinical signs, visual acuity, keratometry, pachymetry, refractive error, and known risk factors (family history, history of allergy, dry eye, and systemic diseases). Diagnosis of keratoconus was based on a combination of clinical signs and imaging findings, and severity was graded using the Amsler-Krumeich classification. Descriptive analysis and chi-square tests were performed to assess associations between variables. Results There was a total of 189 participants, most of who were aged 21–30 years (38.6%, n = 73), females (53.4%, n = 101), had Indian background (50.8%, n = 96), and many lived in the urban areas (91%, n = 172). Eye rubbing was reported in 45.5% (n = 86) and was significantly associated with ethnicity (p = 0.047) and occupation (p = 0.027). Advanced keratoconus (K > 55D) was present in ~ 30% of eyes. Common signs included Munson’s sign (27%, n = 44), Vogt’s striae (23%, n = 21), and Fleischer’s ring (19%, n = 35). Treatments included corneal cross-linking (24.3%, n = 47), glasses (13.8%, n = 27), and scleral lenses (11.6%, n = 21). Mean visual acuity improved post-treatment (mean LogMAR: right eye from 0.53 to 0.29; left eye from 0.51 to 0.30). Conclusion This study provides the first comprehensive profile of keratoconus in Trinidad and Tobago, revealing a predominance among young adults of Indian descent and a substantial number of advanced cases at diagnosis. These findings highlight the need for early detection strategies, public education, and improved access to diagnostic and therapeutic interventions in the region.