What is the quality-of-life status of patients with keratoconus who have not had a surgical intervention? A systematic review.

The aim was to assess the overall quality of life (QoL) of keratoconic patients who had not undergone surgical interventions by evaluating domain scores such as symptoms, activity limitation, psychological changes, mental health and social wellbeing. The search strategy was conducted using five different search platforms (PubMed, Medline, Scopus, Emcare, CINAHL). We included prospective or retrospective studies assessing the quality of life of patients with keratoconus who have not had a surgical intervention to manage their keratoconus. Data collected were assessed according to their psychometric properties, validity, reliability and responsiveness. Articles were screened for suitability and data were extracted. Bias was assessed with Cochrane RoB2.0 tool and ROBIN - I tool. Six hundred and thirty one results were yielded from the searches and a total of 70 articles were screened based on the inclusion and exclusion criteria. A final total of 26 articles were included. Studies had sample sizes ranging from 25 to 1209 participants with keratoconus. The NEI VFQ was the most used tool to evaluate vision-related QoL (VRQoL) being used in 16 studies. Contact lens wear was the most common non-surgical intervention in 13 studies showing improvements in certain domains. The assessment of VRQoL across the studies revealed moderate to significant impairments in several key QoL domains including emotional, social and economic well-being. Patients with keratoconus who have not undergone surgery experienced significant impact on both physical and psychological dimensions. While contact lenses can improve visual function especially in the early stages of the disease but had limitations.