Humanistic and Economic Burden of Patients With Keratoconus

Background and objective Keratoconus is a chronic, progressive corneal disease that occurs primarily in people of working age and significantly affects visual function. However, its broader impact on vision-related quality of life (VRQoL), work productivity, and functional capacity remains poorly investigated. The primary objective of this study was to assess the impact of keratoconus on VRQoL and work productivity. Secondary objectives included the evaluation of daily activity impairment and the investigation of associations between these outcomes and demographic, clinical, and economic factors. Methods A cross-sectional study was conducted in patients with keratoconus, who completed the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and the Work Productivity and Activity Impairment (WPAI) Questionnaire. Demographic and clinical data, including Amsler-Krumeich staging and type of treatment, were collected. Associations were assessed using univariate and multivariate analyses. Results Reduced VRQoL was significantly associated with increased presenteeism, overall work productivity loss, and functional disability. The VFQ-25 subscales for near and distance vision activities, mental health, and caregiver dependence showed the strongest associations. Higher age, advanced stages of keratoconus, especially in the worse eye, and surgical treatment were associated with lower VRQoL. No independent association was observed between VRQoL and annual treatment costs. Conclusions Keratoconus imposes a substantial functional and psychosocial burden, significantly impairing VRQoL and work productivity. Reduced VRQoL was strongly associated with increased presenteeism, overall productivity loss, and activity impairment, highlighting its role as a key indicator of disease burden. Disease severity, older age, and surgical treatment were identified as important determinants of poorer outcomes. These findings underscore the importance of early detection and comprehensive, patient-centered management strategies, including the routine assessment of VRQoL and functional outcomes in clinical practice.