ArticleTranslational vision science & technology2026
Role of Ethnicity and Age in Corneal Curvature and Thickness Changes Following Corneal Cross-Linking for Keratoconus.
Article in Translational vision science & technology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To investigate the effect of corneal cross-linking (CXL) on corneal curvature and thickness in two different keratoconic populations, one based in the Middle East (Saudi Arabia) and one in Europe (UK), and to explore whether age and ethnicity play a role in CXL outcomes. Methods: This study included 208 eyes of 197 keratoconic patients (130 males and 67 females; ages 13-52 years) for the UK cohort and 362 eyes of 329 keratoconic patients (226 males and 136 females; ages 12-51 years) were included for the Saudi cohort. All patients underwent epithelium-off accelerated CXL (ultraviolet-A irradiation of 10 mW/cm2 for 9 minutes) and riboflavin 0.1% solution in both locations. Patients were divided into three age groups: ≤18 years, 19 to 27 years, and ≥28 years. CXL outcomes were assessed using Scheimpflug imaging during 3-year follow-ups and compared across cohorts from both countries. Results: Baseline maximum keratometry (Kmax) and pachymetry were 64.32 ± 8.07 D and 441 ± 33.52 µm for the UK cohort and 54.60 ± 7.59 D and 462 ± 36.38 µm for the Saudi cohort, respectively. At 3 years post-CXL, Kmax improved or stabilized (change in Kmax > -1 D) in 47 eyes (82.45%) in the UK cohort and in 188 eyes (84.30%) in the Saudi cohort, with significant improvements of 1.30 ± 3.00 D (P = 0.003) and 1.2 ± 2.91 D (P < 0.001), respectively. Pachymetry was significantly reduced for both cohorts (P = 0.001 and P < 0.001, respectively). Kmax did not show significant changes in any age group post-CXL in the UK cohort, whereas Kmax significantly improved in all age groups in the Saudi cohort. Conclusions: Keratoconus presented at a more severe stage in the UK cohort compared to the Saudi cohort. Despite this difference in baseline severity, CXL contributed to stabilize keratoconus progression in most patients in both populations. When each cohort was considered independently, the effect of CXL was comparable across all age groups, with no age group demonstrating greater benefit. Translational Relevance: This work identified the effectiveness of CXL for keratoconus at different severities and for different age groups and ethnicities, suggesting the significance of facilitating access to CXL to maximize treatment outcomes.
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