Investigate trends in keratoconus (KCN) treatment patterns and diagnosis age from 2015 to 2020 and evaluate sociodemographic associations with the treatment approach. Retrospective cohort study. Patients with a new KCN diagnosis from 2015 to 2020 were identified in the Academy IRIS® Registry (Intelligent Research in Sight). Associations between sociodemographic factors and treatment were evaluated using multivariable logistic regression. Outcomes included percentages and rates of each treatment (collagen crosslinking [CXL], keratoplasty, or no procedure) from 2015 to 2020, age at diagnosis during this period, and sociodemographic factors associated with treatment type. A total of 66 199 patients with a new diagnosis of KCN were identified. The percentage of patients undergoing CXL increased from 0.05% in 2015 to 29.5% in 2020 ( 0.008). The average age (standard deviation) of KCN patients decreased from 44.1 (±16.9) years in 2015 to 39.2 (±16.9) years in 2020 ( 0.001). In multivariable analyses comparing CXL versus no procedure and keratoplasty versus no procedure, patients undergoing CXL tended to be younger with the odds of having CXL decreasing with increasing age, for example, comparing CXL and no procedure patients, using ages 0–20 years as reference, the odds ratio (OR) (95% confidence interval [CI]) decreased from 0.62 (0.57–0.67; 0.0001) for patients aged 21–40 years to 0.03 (0.02–0.04; 0.0001) for patients aged > 60 years. Men were more likely than women to have CXL (OR, 1.31; 95% CI, 1.23–1.40; 0.0001) and keratoplasty (OR, 1.30; 95% CI, 1.19–1.42; 0.0001). Black patients were less likely than White patients to have CXL (OR, 0.70; 95% CI, 0.63–0.77; 0.0001) and more likely to have keratoplasty (OR, 2.24; 95% CI, 2.01–2.50; 0.0001). Likewise, Hispanic patients had higher odds of CXL (OR, 1.12; 95% CI, 1.00–1.24; 0.05) and keratoplasty (OR, 1.29; 95% CI, 1.12–1.50; 0.001) compared with non-Hispanic patients. Collagen crosslinking and keratoplasty also varied by region and insurance status. A significant increase in use of CXL was noted from 2015 to 2020. Sociodemographic differences in treatment among KCN patients may reflect differences in access, use, or care patterns, and future studies should aim to identify strategies to improve access for all patients. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

中文翻译：

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2015-2020 年圆锥角膜管理的趋势和社会人口模式：美国眼科学会 IRIS® 注册分析

调查 2015 年至 2020 年圆锥角膜 (KCN) 治疗模式和诊断年龄的趋势，并评估社会人口统计学与治疗方法的关联。回顾性队列研究。 2015 年至 2020 年新诊断 KCN 的患者在 Academy IRIS® 注册表（智能研究视野）中进行了识别。使用多变量逻辑回归评估社会人口因素与治疗之间的关联。结果包括 2015 年至 2020 年每种治疗（胶原交联 [CXL]、角膜移植术或不手术）的百分比和比率、该时期诊断时的年龄以及与治疗类型相关的社会人口统计学因素。总共确定了 66 199 名新诊断为 KCN 的患者。接受 CXL 的患者比例从 2015 年的 0.05% 增加到 2020 年的 29.5% (0.008)。 KCN患者的平均年龄（标准差）从2015年的44.1（±16.9）岁下降到2020年的39.2（±16.9）岁（0.001）。在比较 CXL 与不手术、角膜移植术与不手术的多变量分析中，接受 CXL 的患者往往更年轻，随着年龄的增加，患 CXL 的几率降低，例如，比较 CXL 和不手术的患者，使用年龄 0-20 岁作为参考，比值比 (OR)（95% 置信区间 [CI]）从 21-40 岁患者的 0.62（0.57-0.67；0.0001）下降到 60 岁以上患者的 0.03（0.02-0.04；0.0001）。男性比女性更有可能接受 CXL（OR，1.31；95% CI，1.23–1.40；0.0001）和角膜移植术（OR，1.30；95% CI，1.19–1.42；0.0001）。黑人患者比白人患者更不可能进行 CXL（OR，0.70；95% CI，0.63-0.77；0.0001），并且更可能进行角膜移植术（OR，2.24；95% CI，2.01-2.50；0.0001）。同样，与非西班牙裔患者相比，西班牙裔患者接受 CXL（OR，1.12；95% CI，1.00-1.24；0.05）和角膜移植术（OR，1.29；95% CI，1.12-1.50；0.001）的几率更高。胶原交联和角膜移植术也因地区和保险状况而异。从 2015 年到 2020 年，CXL 的使用显着增加。KCN 患者治疗中的社会人口统计学差异可能反映了可及性、使用或护理模式的差异，未来的研究应旨在确定改善所有患者可及性的策略。作者对本文讨论的任何材料没有专有或商业利益。