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Records of patients aged 10\u201345\u00a0years who attended refraction services between January 2014 and December 2018 were reviewed. KC cases were ascertained using predefined clinical criteria. Analyses were performed using R version 4.5.1 (R Foundation for Statistical Computing).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 1,400 targeted records, 1,180 (84.3%) were successfully retrieved. The facility-based proportion of KC was 5.7% (67\/1180; 95% CI: 4.4\u20137.2%). KC was most common among individuals aged 18\u201335\u00a0years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and varied significantly by facility and region (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.005). Blurred vision was the predominant presenting complaint (88.1%), while diagnosis relied primarily on retinoscopy, slit-lamp examination, and keratometry. Significant inter-eye differences were observed for best-corrected visual acuity and astigmatic axis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.005), but not for keratometric measurements. Median visual acuity improved from 0.2 to 0.6 following refractive correction. In multivariable analyses, cylindrical refractive error remained independently associated (AUC \u2248 0.88) with KC, whereas age and gender were not. Sensitivity analyses produced findings consistent with the primary results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Keratoconus represents a substantial clinical burden within Malawi\u2019s tertiary eye-care system and is associated with considerable visual impairment. Strengthening early detection, access to corneal imaging, specialised rehabilitation services, and clinical information systems may improve diagnosis, management, and visual outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10792-026-04161-0","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:49:17Z","timestamp":1784087357000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Proportion and clinical characteristics of keratoconus among patients attending refraction units: a retrospective facility-based study in Malawi"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6679-1784","authenticated-orcid":false,"given":"Leaveson","family":"Thom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1942-974X","authenticated-orcid":false,"given":"Vanessa V. 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