Corneal Collagen Crosslinking and Vision-Related Quality of Life: Outcomes in Keratoconus Patients

INTRODUCTION: Keratoconus (KC) is a progressive corneal ectatic disorder that significantly impacts patients’ quality of life. This study aims to evaluate the effect of corneal collagen crosslinking (CXL) on vision-related quality of life in keratoconus patients using the Portuguese version of the Keratoconus Outcomes Research Questionnaire (KORQ). METHODS: Prospective observational study including patients with progressive KC who underwent CXL, as well as a group of stable KC patients without indications for treatment. Patients undergoing CXL completed the KORQ before treatment and six months after. Patients not receiving any treatment also answered the questionnaire at the same time points. A comparison between the KORQ scores of both groups was performed. Relations between KORQ scores and best-corrected visual acuity (BCVA), keratometric and refractive parameters were also assessed. RESULTS: In the CXL group, the Activity Limitation (AL) subscale improved from 50.86 preoperatively to 52.09 (p=0.746) six months after treatment, while the Symptoms subscale showed a greater increase from 46.86 to 54.80 (p=0.080). The BCVA significantly improved from 0.327 to 0.157 logMAR (p<0.05). Significant reductions (p<0.05) were also observed in maximum keratometry (Kmax), flattest keratometry (K1), and steepest keratometry (K2). In contrast, untreated patients exhibited minimal changes in both visual parameters and KORQ scores. A significant interaction (p=0.036) was observed between time and treatment in the Symptoms subscale, indicating that the CXL group experienced a greater improvement in symptom perception over time. CONCLUSION: This study underscores the effectiveness of CXL in treating keratoconus by stabilizing the disease and seeming to improve symptom perception. Using patient-reported outcome measures like KORQ is crucial for accurately assessing the impact of the disease and its treatments on patients’ quality of life.