Keratoconus Symptoms Reduce Quality of Life in Women, The Employed

Macro photo of the human eye with corneal disease keratoconus
Degenerative-dystrophic disease of the human cornea – keratoconus.
Female sex and being actively employed was associated with limited quality of life in terms of symptomological factors for patients with keratoconus.

Poorer visual acuity (VA) and greater wavefront aberrations lead to a diminished quality of life (QOL) in patients with keratoconus, according to research published in Ophthalmic and Physiological Optics. Women and individuals who are employed reported experiencing greater QOL limiting factors in terms of symptomatology than men and individuals who are unemployed, respectively.  

Researchers enrolled 574 patients with keratoconus (24.5±5.1 years, 57% men) in a study to identify factors affecting QOL. They stratified patients into 4 groups based on keratoconus severity: mild (<48 D), moderate (48-53 D), advanced (54-55 D), and severe (>55 D). The team performed refractions, slit lamp evaluations, and corneal topography measurements on all participants and administered the Keratoconus Outcomes Research Questionnaire (KORQ). They retetested a subset of 38 participants a mean 16.2±8.3 days after the initial visit to establish test-retest reliability. Investigators also collected demographic information to assess associations of age, sex, laterality, severity, duration, education, and employment with QOL.

The team found that activities were limited by poorer VA — both in the best- and worst-seeing eye (r=-0.10; P =.01 and r=-0.09; P =.04, respectively). Women scored 21% worse than men in the symptoms portion of the KORQ (95% CI, -0.09 to -0.59; P =.001), and individuals who were employed scored worse than those who were not employed ((β=0.44; 95% CI, 0.17-0.70; P =.001). Participants most commonly reported that dusty days exacerbated their symptoms. 

Nonsignificant differences in activity and symptom scores from zero (P =.22 and P =.20, respectively) indicated test-retest reliability. 

“Even the mild form of keratoconus can have a significant and independent impact on visual functioning, and these patients were very troubled by the symptoms suggesting that they need as much monitoring as for severe cases of keratoconus,” according to the researchers. They also urge that considering gender and employment status “is important when adopting a person-centred approach in the management of patients with keratoconus.”

Study limitations include a disproportionate representation of men, individuals with a college education or higher, and individuals living in an urban area in the sample.  


Gothwal VK, Gujar R, Sharma S, Begum N, Pesudovs K. Factors affecting quality of life in keratoconus. Ophthalmic Physiol Opt. Published online May 30, 2022. doi:10.1111/opo.13010