Sir,
We are pleased that Cozma et al have been able to support our finding (Georgiou et al1) of a higher incidence of keratoconus in Asian populations, particularly those from Pakistan.
We understand cultural differences in contact lens wear may influence the incidence of keratoconus between the ethnic groups, however, the evidence for this to cause such a significant difference is limited. Weed et al2 reported only 28% of patients presenting with a new diagnosis of keratoconus had a history of contact lens use. In our study, the most common treatments for refractive error, prior to referral, were glasses or soft contact lens rather than rigid lens, which are postulated to be the most likely cause for keratoconus. Interestingly, in our study, there was no significant difference in initial hospital treatment between the white and Asian patients. A total of 41% of white patients and 44% of Asian patients were treated with contact lens.
Cozma et al's findings further support the theory of a genetic basis to keratoconus and emphasizes the need for genetic research.
References
Georgiou T, Funnell CL, Cassels-Brown A, O'Conor R . Influence of ethnic origin on the incidence of keratoconus and associated disease in Asians and white patients. Eye 2004; 18: 379–383.
Weed KH, McGhee CNJ . Referral patterns, treatment management and visual outcome in keratoconus. Eye 1998; 12: 663–668.
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Georgiou, T., Funnell, C., Cassels-Brown, A. et al. Reply to I Cozma et al. Eye 19, 925–926 (2005). https://doi.org/10.1038/sj.eye.6701678
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DOI: https://doi.org/10.1038/sj.eye.6701678
