Prevalence of Keratoconus and Associated Risk Factors Among High School Students in Couva, Trinidad: A Cross-Sectional Study

<b>Purpose:</b> This study aimed to determine the prevalence and associated risk factors of keratoconus (KC) among high school students in Couva, Trinidad and Tobago. <b>Method:</b> A cross-sectional, school-based approach was used, involving a simple random sampling technique to select schools and students. A structured questionnaire assessed KC risk factors, while clinical assessments, including visual acuity, refraction, slit lamp biomicroscopy, and topography, were performed. Data were analyzed using R. Exact tests were used for KC (<i>n</i> = 2 cases) and robust Poisson regression estimated adjusted prevalence ratios for the 'at-risk' screening endpoint. <b>Results:</b> A total of 432 students aged 12-17 years participated, with a response rate of 97.5%. Most participants were of East Indian descent (48.1%), female (52.1%), and 14 years old (23.1%). Approximately 47.7% (95% CI 43.0-52.5%) were at risk of KC, with 0.5% (2/432; exact 95% CI 0.06-1.67%) diagnosed with the condition. The most common risk factors were eye rubbing (87.4%), over eight hours of sun exposure weekly (71.8%), and atopy (68.4%). KC was observed to be significantly higher among people with a family history (<i>p</i> = 0.018). <b>Conclusions:</b> The study highlights a low prevalence and a high risk of KC among high school students, with a strong link to family history and common risk factors such as eye rubbing and sun exposure. These findings emphasize the urgent need for regular KC screening in schools to ensure early diagnosis and effective management.