A new international study suggests that corneal cross-linking (CXL) remains broadly effective for keratoconus across different ethnic groups and age ranges, despite notable differences in baseline disease severity.
Published in Translational Vision Science & Technology, the study compared outcomes following epithelium-off accelerated CXL in two geographically and ethnically distinct populations: the UK and Saudi Arabia. The aim was to determine whether ethnicity or age influences post-treatment changes in corneal curvature and thickness.
Keratoconus is known to vary in prevalence and severity across populations, with higher rates reported in Middle Eastern and Asian groups. These differences raise an important clinical question: do such demographic factors influence response to CXL?
To explore this, the UK- and Saudi-based investigators analyzed 570 eyes from 526 patients across both cohorts, with follow-up extending to three years. All patients underwent a standardized protocol of epithelium-off accelerated CXL, and outcomes were assessed using Scheimpflug imaging. Patients were stratified into three age groups (≤18, 19–27, and ≥28 years) to evaluate any age-dependent treatment effects.
At baseline, the UK cohort presented with more advanced disease, with significantly steeper corneas and thinner pachymetry than the Saudi cohort. Despite this disparity, outcomes following CXL remained broadly comparable between the two populations.
At three years, keratoconus stabilized or improved in over 80%of eyes in both groups. Mean Kmax improved by approximately 1.3 D in the UK cohort and 1.2 D in the Saudi cohort – both statistically significant changes. Corneal thinning was observed postoperatively in both populations, consistent with known biomechanical effects of CXL.
When stratified by age, results were similarly reassuring. In the Saudi cohort, significant improvements in corneal curvature were observed across all age groups. In the UK cohort, while Kmax changes did not reach statistical significance within age subgroups, overall disease stabilization remained high. Importantly, no age group demonstrated a clearly superior response to treatment.
Taken together, the findings suggest that neither ethnicity nor age substantially alters the effectiveness of CXL in halting keratoconus progression.
Instead, the authors highlight baseline disease severity as a more prominent distinguishing factor between populations. They suggest that “stratifying patients with keratoconus based on their risk of progression (i.e., age and baseline severity) may contribute to minimizing the potential continued progression for those awaiting CXL treatment, particularly in areas with large keratoconic populations and/or limited access to CXL services.”
For clinicians, the study reinforces the role of CXL as a reliable intervention across diverse patient groups. It also supports offering treatment broadly, rather than delaying based on age or demographic considerations alone.
While further research may refine patient selection and timing, this study adds to a growing body of evidence supporting the generalizability of CXL outcomes across global populations.
Published in Translational Vision Science & Technology, the study compared outcomes following epithelium-off accelerated CXL in two geographically and ethnically distinct populations: the UK and Saudi Arabia. The aim was to determine whether ethnicity or age influences post-treatment changes in corneal curvature and thickness.
Keratoconus is known to vary in prevalence and severity across populations, with higher rates reported in Middle Eastern and Asian groups. These differences raise an important clinical question: do such demographic factors influence response to CXL?
To explore this, the UK- and Saudi-based investigators analyzed 570 eyes from 526 patients across both cohorts, with follow-up extending to three years. All patients underwent a standardized protocol of epithelium-off accelerated CXL, and outcomes were assessed using Scheimpflug imaging. Patients were stratified into three age groups (≤18, 19–27, and ≥28 years) to evaluate any age-dependent treatment effects.
At baseline, the UK cohort presented with more advanced disease, with significantly steeper corneas and thinner pachymetry than the Saudi cohort. Despite this disparity, outcomes following CXL remained broadly comparable between the two populations.
At three years, keratoconus stabilized or improved in over 80%of eyes in both groups. Mean Kmax improved by approximately 1.3 D in the UK cohort and 1.2 D in the Saudi cohort – both statistically significant changes. Corneal thinning was observed postoperatively in both populations, consistent with known biomechanical effects of CXL.
When stratified by age, results were similarly reassuring. In the Saudi cohort, significant improvements in corneal curvature were observed across all age groups. In the UK cohort, while Kmax changes did not reach statistical significance within age subgroups, overall disease stabilization remained high. Importantly, no age group demonstrated a clearly superior response to treatment.
Taken together, the findings suggest that neither ethnicity nor age substantially alters the effectiveness of CXL in halting keratoconus progression.
Instead, the authors highlight baseline disease severity as a more prominent distinguishing factor between populations. They suggest that “stratifying patients with keratoconus based on their risk of progression (i.e., age and baseline severity) may contribute to minimizing the potential continued progression for those awaiting CXL treatment, particularly in areas with large keratoconic populations and/or limited access to CXL services.”
For clinicians, the study reinforces the role of CXL as a reliable intervention across diverse patient groups. It also supports offering treatment broadly, rather than delaying based on age or demographic considerations alone.
While further research may refine patient selection and timing, this study adds to a growing body of evidence supporting the generalizability of CXL outcomes across global populations.
