Vision-Related Quality of Life in Keratoconus: A KORQ-Based Cross-Sectional Study

Abstract

Background: Keratoconus is a progressive corneal ectatic disorder that leads to irregular astigmatism, higher-order aberrations, and significant visual disturbances. Although clinical management focuses on corneal stability and visual acuity, these measures often fail to capture the functional and symptomatic burden experienced by patients in daily life. Disease-specific patient-reported outcome measures are therefore essential for comprehensive assessment of vision-related quality of life in keratoconus.
Aim: To evaluate the impact of keratoconus on vision-related quality of life using the Keratoconus Outcomes Research Questionnaire (KORQ) and to analyse the association of quality-of-life outcomes with demographic and functional variables.
Methods: A cross-sectional observational study was conducted among patients diagnosed with keratoconus attending a tertiary eye care centre. Vision-related quality of life was assessed using the KORQ, which includes Activity Limitation and Symptoms domains. Demographic data, including age, gender, and occupational status, were collected. Data were analysed using Jamovi statistical software. Descriptive statistics, independent samples tests, correlation analysis, and one-way analysis of variance were employed as appropriate, with statistical significance set at p < 0.05. As sensitivity analyses, non-parametric equivalents (Mann–Whitney U test, Spearman’s correlation, Kruskal–Wallis test) were additionally applied given non-normality of activity limitation scores, and multivariate linear regression was performed to identify independent predictors of activity limitation while adjusting for age, gender, and occupation. Internal consistency of the KORQ domains was assessed using Cronbach’s alpha.
Results: A total of 164 participants were included in the analysis. No statistically significant gender-based differences were observed in activity limitation or symptom scores. Age demonstrated a moderate positive correlation with activity limitation and a weaker but significant association with symptom severity. A significant positive relationship was observed between symptom burden and activity limitation. Occupational differences in activity limitation were statistically significant on non-parametric testing (Kruskal–Wallis, p = 0.001). However, multivariate regression adjusting for age and gender showed that occupation was not an independent predictor of activity limitation, whereas age remained significantly and independently associated with activity limitation (p < 0.001); this indicates the univariate occupational effect was substantially confounded by age, as students (the largest occupational group) were considerably younger than other groups. Symptom scores remained comparable across occupational groups.
Conclusion: Keratoconus significantly affects vision-related quality of life, primarily through functional limitations and symptom burden. Age was independently associated with greater functional impairment, whereas the apparent occupational effect appeared largely attributable to age differences between occupational groups rather than occupation itself; gender did not appear to be a major determinant. Given the cross-sectional design, these associations should not be interpreted as causal. The findings support the routine use of disease-specific quality-of-life measures, such as the KORQ, to complement clinical assessment and guide patient-centred keratoconus management.