Clinical Evaluation and Validation of the Dutch Crosslinking for Keratoconus Score
Clinical Evaluation and Validation of the Dutch Crosslinking for Keratoconus Score
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DOI：
10.1001/jamaophthalmol.2019.0415
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发表时间：
2019-06-01
影响因子：
8.1
通讯作者：
Godefrooij, Daniel A.
中科院分区：
文献类型：
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作者：
Wisse, Robert P. L.;Simons, Rob W. P.;Godefrooij, Daniel A.
定义圆锥角膜的进展是临床决策的基础，因为当疾病被认为是进展时，需要进行交联治疗。目前，对于应该使用哪些参数来定义进展还没有达成共识。目的评估和验证一种新的临床评分系统，作为一种易于使用的评估工具，用于圆锥角膜交联治疗。设计、环境和参与者：2个学术治疗中心的前瞻性队列研究。纳入2012年1月1日至2014年6月30日期间就诊的圆锥角膜患者，随访2年。分析开始于2017年3月。干预措施：荷兰圆锥角膜交联（DUCK）评分是基于5个临床参数的变化，这些参数是常规评估的：年龄、视力、屈光误差、角膜测量和主观患者经验。DUCK评分由每个项目得分0到2分得出，截止点由临床经验确定。在过去12个月内，我们将DUCK评分与传统的最大角膜测量标准增加1.0屈光度进行了纵向发现和验证队列的比较。进行敏感性分析和项目内相关性分析。主要结果和措施：总治疗率下降和适当保留治疗率。结果388例患者共504只眼，在12个月和24个月期间进行疾病进展分析。发现队列和验证队列的基线患者特征在年龄（平均[SD]， 26.8[8.3]岁vs 26.3[9.1]岁）、性别（332名男性中有216名[65%]vs 172名[72%]男性中有123名）和最大角膜测量值（平均[SD]， 53.5 [7.1] vs 52.7[6.3]）方面具有可比性。坚持DUCK评分，而不是最大角膜测光，与总治疗率降低23% （95% CI, 18%-30%）相关，而不增加疾病进展的风险（即，两组的进展率相等；0%）。DUCK评分似乎更好地识别了35%的适当拒绝治疗的眼睛（95% CI, 22%-49%）。结论和相关性这些结果验证了DUCK评分作为确定交联治疗是否有必要的工具。与传统的最大屈光度大于1.0的标准相比，DUCK评分可以更好地选择可能受益于交联治疗的患者。潜在地，它可以防止不必要的治疗，减少暴露于治疗风险，并提高交联的成本效益。
ImportanceDefining keratoconus progression is fundamental in clinical decision making because crosslinking treatments are indicated when the disease is considered progressive. Currently, there is no consensus which parameters should be used to define progression. ObjectiveTo assess and validate a novel clinical scoring system as an easy-to-use assessment tool for crosslinking treatment in patients with keratoconus. Design, Setting, and ParticipantsProspective cohort study at 2 academic treatment centers. Patients with keratoconus referred between January 1, 2012, and June 30, 2014, with 2-year follow-up were included. Analysis began March 2017. InterventionsThe Dutch Crosslinking for Keratoconus (DUCK) score is based on changes in 5 clinical parameters that are routinely assessed: age, visual acuity, refraction error, keratometry, and subjective patient experience. The DUCK score is derived by scoring 0 to 2 points per item, and cutoffs were determined by clinical experience. We compared the DUCK scores to the conventional 1.0-diopter increase in maximum keratometry criterion, within the last 12 months, in a longitudinal discovery and a validation cohort. Sensitivity analyses and intraitem correlations were performed. Main Outcomes and MeasuresOverall treatment rate reduction and the duly withheld treatment rate. ResultsA total of 504 eyes of 388 patients were available for analysis on disease progression in the course of 12 and 24 months. Baseline patient characteristics of the discovery cohort and the validation cohort were comparable in terms of age (mean [SD], 26.8 [8.3] years vs 26.3 [9.1]), sex (216 of 332 [65%] vs 123 of 172 [72%] men), and maximum keratometry (mean [SD], 53.5 [7.1] vs 52.7 [6.3]). Adhering to the DUCK score, rather than maximum keratometry, was associated with a reduction in overall treatment rate by 23% (95% CI, 18%-30%), without increasing the risk of disease progression (ie, the rate of progression for both groups was equal; 0%). The DUCK score appears to better identify eyes that were duly withheld treatment by 35% (95% CI, 22%-49%). Conclusions and RelevanceThese results provide validation of the DUCK score as a tool to determine whether a crosslinking treatment might be warranted. Compared with the conventional maximum keratometry criterion of more than 1.0 diopter, the DUCK score may better select patients who might benefit from crosslinking treatment. Potentially, it may prevent unnecessary treatments, reduce exposure to treatment risks, and improve the cost effectiveness of crosslinking.