{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:28:48Z","timestamp":1792798128431,"version":"4.5.0"},"reference-count":85,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2015,8,18]],"date-time":"2015-08-18T00:00:00Z","timestamp":1439856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Hadassah Academic College Research Authority","id":[{"id":"https:\/\/ror.org\/03bdv1r55","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmic Physiologic Optic"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Keratoconus (\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      ) is a progressive corneal thinning disorder with an uncertain aetiology. Environmental and genetic factors, including consanguinity, eye rubbing and possibly sun exposure, play a role in the aetiology of\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      . Here we test for risk factors for\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      in an Israeli population with particular emphasis on sun exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This case\u2013control study included\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      patients who were diagnosed at Care Laser Medical Group, a refractive surgery clinic with branches throughout Israel. The control group included age, sex and ethnicity matched individuals who were randomly selected from patients presenting at the clinic for refractive surgery, but without\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      . Study subjects were asked to fill out a self\u2010administered questionnaire that included demographic and geographic details, questions on ocular and general health and sun exposure. Conditional logistic regression was used to analyse univariable and multivariable data to identify risk factors for\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010three\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      patients and 146 controls participated in the study. Univariable analyses demonstrated that eye rubbing [odds ratio (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      )\u00a0=\u00a03.76], positive family history of\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a06.10) and parents' education (&lt;12\u00a0years,\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a00.27, 0.23 for father's and mother's education respectively) were significant risk factors for\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      . Univariable analyses of sun exposure behaviour during teenage years proved equivocal with some behaviours emerging as protective for\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      (\n                      <jats:italic>wearing a hat outdoors<\/jats:italic>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a03.13) or as risk factors (\n                      <jats:italic>spending time in the shade<\/jats:italic>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a00.45), while others showed no association [\n                      <jats:italic>limiting time in the sun<\/jats:italic>\n                      (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.51), and\n                      <jats:italic>wearing sunglasses<\/jats:italic>\n                      (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.20)]. Most of the factors that were significant in the univariable analyses, also emerged as statistically significant in the multivariable model (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a03.37, 9.68, 0.35, 5.51 for\n                      <jats:italic>eye rubbing, family history, parental education<\/jats:italic>\n                      ,\n                      <jats:italic>wearing a hat outdoors<\/jats:italic>\n                      , with the exception of\n                      <jats:italic>spending time in the shade<\/jats:italic>\n                      (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.88).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Eye rubbing, parents' education (as a measure of socio\u2010economic status) and having family members with\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      emerged as significant risk factors for\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      . The role of sun exposure in\n                      <jats:styled-content style=\"fixed-case\">KC<\/jats:styled-content>\n                      remains equivocal and warrants further research.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/opo.12237","type":"journal-article","created":{"date-parts":[[2015,8,18]],"date-time":"2015-08-18T20:02:59Z","timestamp":1439928179000},"page":"673-681","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":69,"title":["Risk factors for keratoconus in Israel: a case\u2013control study"],"prefix":"10.1007","volume":"35","author":[{"given":"Ariela","family":"Gordon\u2010Shaag","sequence":"first","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Millodot","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Sciences Cardiff University Cardiff Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Kaiserman","sequence":"additional","affiliation":[{"name":"CARE Laser Medical Group Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzahi","family":"Sela","sequence":"additional","affiliation":[{"name":"CARE Laser Medical Group Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Barnett Itzhaki","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaffa","family":"Zerbib","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efrat","family":"Matityahu","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Shkedi","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Miroshnichenko","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Einat","family":"Shneor","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science Hadassah Academic College Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2015,8,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2013.278"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(84)90094-8"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6257(97)00119-7"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10025-1002"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-9071.2001.d01-16.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0896-1549(03)00099-3"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.4172\/2161\u2010038X.S6\u2010001"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2012.02448.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2012.02400.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31823f8c72"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e31828da95c"},{"key":"e_1_2_7_13_1","first-page":"9","article-title":"Prevalence of keratoconus amoung young Arab students in Israel","volume":"3","author":"Shneor E","year":"2014","journal-title":"Int J KC & Ectatic Corneal Dis"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/795738"},{"key":"e_1_2_7_15_1","first-page":"10","article-title":"Everett Kinsey lecture. 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