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The aim of our study was to investigate the prevalence of keratoconus in a large German cohort and to evaluate possible associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>In the population-based, prospective, monocentric cohort study, Gutenberg Health Study, 12,423 subjects aged 40\u201380\u00a0years were examined at the 5-year follow-up. Subjects underwent a detailed medical history and a general and ophthalmologic examination including Scheimpflug imaging. Keratoconus diagnosis was performed in two steps: all subjects with conspicuous TKC analysis of corneal tomography were included in further grading.<\/jats:p>\n                    <jats:p>Prevalence and 95% confidence intervals were calculated. Logistic regression analysis was carried out to investigate association with age, sex, BMI, thyroid hormone, smoking, diabetes, arterial hypertension, atopy, allergy, steroid use, sleep apnea, asthma, and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 10,419 subjects, 75 eyes of 51 subjects were classified as having keratoconus. The prevalence for keratoconus in the German cohort was 0.49% (1:204; 95% CI: 0.36\u20130.64%) and was approximately equally distributed across the age decades. No gender predisposition could be demonstrated.<\/jats:p>\n                    <jats:p>Logistic regression showed no association between keratoconus and age, sex, BMI, thyroid hormone, smoking, diabetes, arterial hypertension, atopy, allergy, steroid use, sleep apnea, asthma, and depression in our sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of keratoconus disease in a mainly Caucasian population is approximately tenfold higher than previously reported in the literature using latest technologies (Scheimpflug imaging). Contrary to previous assumptions, we did not find associations with sex, existing atopy, thyroid dysfunction, diabetes, smoking, and depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00417-023-06132-y","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T01:04:31Z","timestamp":1686704671000},"page":"3241-3247","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Much higher prevalence of keratoconus than announced results of the Gutenberg Health Study (GHS)"],"prefix":"10.1007","volume":"261","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1831-0210","authenticated-orcid":false,"given":"Susanne","family":"Marx-Gross","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achim","family":"Fie\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp Sebastian","family":"Wild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred Elmar","family":"Beutel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Schmidtmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl Johannes","family":"Lackner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Karl-Georg","family":"Schuster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,14]]},"reference":[{"key":"6132_CR1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.jcrs.2005.12.092","volume":"32","author":"M Kohlhaas","year":"2006","unstructured":"Kohlhaas M, Spoerl E, Schilde T, Unger G, Wittig C, Pillunat LE (2006) Biomechanical evidence of the distribution of cross-links in corneas treated with riboflavin and ultraviolet A light. 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Congress DOG, Berlin, Germany.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving were in accordance with the ethical standards of the ethics committee of the Medical Chamber of Rhineland-Palatinate, Mainz, Germany and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all study participants prior to their study entry and the GHS complies with Good Clinical Practice (GCP), Good Epidemiological Practice (GEP). The study protocol and study documents were approved by the ethics committee of the Medical Chamber of Rhineland-Palatinate, Mainz, Germany (reference no. 837.020.07; original vote: 22.3.2007, latest update: 20.10.2015).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All authors: There are no conflicts of interest reported regarding this work. The Gutenberg Health Study is funded through the Government of Rhineland-Palatinate (\u201cStiftung Rheinland-Pfalz f\u00fcr Innovation,\u201d contract AZ 961\u2013386261\/733), the research programs \u201cWissen schafft Zukunft\u201d and \u201cCenter for Translational Vascular Biology (CTVB)\u201d of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study.SMG: outside the submitted work, she reports grants from Bayer AG.AS is supported by the Intramural Research Funding (Stufe I) of the University Medical Center of Johannes Gutenberg University Mainz and the Ernst- und Berta-Grimmke Stiftung and the Else Kr\u00f6ner-Fresenius-Stiftung.TM is PI of the German Center for Cardiovascular Research (DZHK), outside this he has no relevant financial or non-financial interests to disclose. Wild PS is funded by the Federal Ministry of Education and Research (BMBF 01EO1503) and he and M\u00fcnzel T are PI of the German Center for Cardiovascular Research (DZHK). Wild PS is principal investigator of the DIASyM research core (BMBF 161L0219).PSW: Outside the submitted work, PSW reports grants from Bayer AG, non-financial grants from Philips Medical Systems, grants and consulting fees from Boehringer Ingelheim, grants and consulting fees from Novartis Pharma, grants and consulting fees from Sanofi-Aventis, grants, consulting and lecturing fees from Bayer Health Care, grants and consulting fees from Daiichi Sankyo Europe, lecturing fees from Pfizer Pharma, lecturing fees from Bristol Myers Squibb, consulting fees from Astra Zeneca, consulting fees and non-financial support from Diasorin and non-financial support from IEM. PSW is funded by the European Regional Development Fund and the Ministry of Science and Health of the State of Rhineland-Palatinate (EFRE\/REACT-EU, Grant No. 84007232 and No. 84009735), the Federal Ministry of Education and Research (BMBF 01EO1503, 81Z0210103, 81Z0210102, 03ZU1202AA, 03ZU1202CD, 03ZU1202DB, 03ZU1202JC, 03ZU1202KB, 03ZU1202LB, 03ZU1202MB, 03ZU1202OA), Ministry of Science and Health of the State of Rhineland Palatinate (MWG RLP 724\u20130010#2021\/0030\u20131501), the ReALity Initiative of the Life Sciences of the Johannes Gutenberg University Mainz for the establishment of a cell bank, the National Research Network University Medicine on Covid-19 (\u201dNaFoUniMedCovid19\u2033, Grant No. 01KX2021) B-FAST, and the Federal Institute for Occupational Safety and Health (BAuA, F2447 \/ 537727) outside the present work. PSW is principal investigator of the German Center for Cardiovascular Research (DZHK) and principal investigator of the DIASyM research core (BMBF DIASyM research core (BMBF 161L0217A, 031L0217A).MB has no relevant financial or non-financial interests to disclose.IS has no relevant financial or non-financial interests to disclose.KL has no relevant financial or non-financial interests to disclose.NP has no relevant financial or non-financial interests to disclose.AKS: There are no conflicts of interest reported regarding this work. Outside the submitted work, AKS reports grants from Bayer, Novartis and Santen, grants and consulting fees from Abbvie and Apells, non-financial grants from Heidelberg Engineering.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}