{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T00:23:22Z","timestamp":1793579002396,"version":"4.5.0"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Studies have shown that eye rubbing is associated with increased risk of keratoconus (KC). However, the potential mediating roles between eye rubbing and KC remain largely unknown. Hence, this study aims to explore the mediating roles of two specific factors, namely, the inverse of the stiffness parameter at the first applanation (-SPA1) and maximal corneal keratometry (Kmax) values, in the relationship between eye rubbing and KC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 395\u00a0patients with KC and 396 controls from the Chinese keratoconus (CKC) cohort study were included in this case\u2013control analysis. The Spearman correlation and generalized linear regression models were used to analyze the associations between the time of eye rubbing, -SPA1, Kmax, and KC. Furthermore, three mediation models (individual, parallel multiple, and serial multiple) were utilized to investigate the mediating roles of -SPA1 and Kmax in the relationship between eye rubbing and KC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjusting for confounding factors, the odds ratio and 95% confidence interval (CI) for the time of eye rubbing, -SPA1, and Kmax in relation to KC were 1.02 (1.01, 1.04), 1.16 (1.12, 1.19), and 3.86 (2.52, 5.92), respectively. The individual mediation model indicated that the indirect effects of -SPA1 and Kmax were 0.084 and 0.056, respectively. The parallel multiple mediation model showed a total indirect effect of 0.081 for -SPA1 and Kmax. Additionally, the serial multiple mediation model (time of eye rubbing \u2192 -SPA1 \u2192 Kmax \u2192 KC) indicated that following -SPA1, Kmax partially mediated the relationship between the time of eye rubbing and KC with a total indirect effect of 0.024 (95% CI: 0.016\u20130.042), accounting for 14.5% of the total effect (time of eye rubbing on KC), while no significant indirect effect was found for Kmax alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The individual, parallel multiple, and serial multiple mediation analyses consistently demonstrated the mediating roles of -SPA1 and Kmax in linking the duration of eye rubbing to KC. Notably, the serial mediation pathway (time of eye rubbing \u2192 -SPA1 \u2192 Kmax \u2192 KC) exhibited a significant indirect effect. These findings confirm and complement the theoretical framework linking eye rubbing to KC, providing a reference for further exploration of the pathogenesis of KC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2025.1595671","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T01:28:39Z","timestamp":1750901319000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Mediating roles of corneal biomechanical and topographic parameters in eye rubbing and keratoconus based on the Chinese keratoconus cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Kaili","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runqi","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuwei","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anqi","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenchen","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghao","family":"Zang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenjiu","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Oehring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yibin","family":"Hao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengwei","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1097\/ico.0000000000002808","article-title":"Progression of pediatric keratoconus after corneal cross-linking: a systematic review and pooled analysis","volume":"41","author":"Achiron","year":"2022","journal-title":"Cornea"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3651","DOI":"10.1167\/iovs.13-13715","article-title":"Biomechanical responses of healthy and keratoconic corneas measured using a noncontact scheimpflug-based tonometer","volume":"55","author":"Ali","year":"2014","journal-title":"Invest Ophthalmol. Vis. Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/cxo.12038","article-title":"Effects of eye rubbing on the levels of protease, protease activity and cytokines in tears: relevance in keratoconus","volume":"96","author":"Balasubramanian","year":"2013","journal-title":"Clin. Exp. Optom."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/ico.0000000000002781","article-title":"Keratoconus: diagnosis and staging","volume":"41","author":"Belin","year":"2022","journal-title":"Cornea"},{"key":"B5","doi-asserted-by":"publisher","first-page":"108398","DOI":"10.1016\/j.exer.2020.108398","article-title":"Update on the genetics of keratoconus","volume":"202","author":"Bykhovskaya","year":"2021","journal-title":"Exp. Eye Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1007\/s10654-021-00757-1","article-title":"Mendelian randomisation for mediation analysis: current methods and challenges for implementation","volume":"36","author":"Carter","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"978684","DOI":"10.3389\/fgene.2022.978684","article-title":"Identification of genetic variants in five Chinese families with keratoconus: pathogenicity analysis and characteristics of parental corneal topography","volume":"13","author":"Cheng","year":"2022","journal-title":"Front. Genet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"S90","DOI":"10.3928\/1081597x-20080101-16","article-title":"Biomechanical and wound healing characteristics of corneas after excimer laser keratorefractive surgery: is there a difference between advanced surface ablation and sub-Bowman's keratomileusis?","volume":"24","author":"Dawson","year":"2008","journal-title":"J. Refract. Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"300060519892385","DOI":"10.1177\/0300060519892385","article-title":"Measurement of corneal thickness using Pentacam HR versus Nidek CEM-530 specular microscopy","volume":"48","author":"De Bernardo","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/6605771","article-title":"New keratoconus risk factors: a cross-sectional case-control study","volume":"2022","author":"Debourdeau","year":"2022","journal-title":"J. Ophthalmol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e108882","DOI":"10.1371\/journal.pone.0108882","article-title":"Evaluation of intereye corneal asymmetry in patients with keratoconus. A scheimpflug imaging study","volume":"9","author":"Dienes","year":"2014","journal-title":"PloS One"},{"key":"B12","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/s40123-020-00264-8","article-title":"A case of early keratoconus associated with eye rubbing in a Young child","volume":"9","author":"Dimacali","year":"2020","journal-title":"Ophthalmol. Ther."},{"key":"B13","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1016\/j.ophtha.2019.02.029","article-title":"Keratoconus natural progression: a systematic review and meta-analysis of 11 529 eyes","volume":"126","author":"Ferdi","year":"2019","journal-title":"Ophthalmology"},{"key":"B14","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/j.jtos.2020.03.006","article-title":"The keratoconus enigma: a review with emphasis on pathogenesis","volume":"18","author":"Ferrari","year":"2020","journal-title":"Ocul. Surf."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e83","DOI":"10.1111\/aos.14857","article-title":"Reliability analysis of successive Corneal Visualization Scheimpflug Technology measurements in different keratoconus stages","volume":"100","author":"Flockerzi","year":"2022","journal-title":"Acta Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"994353","DOI":"10.3389\/fbioe.2022.994353","article-title":"Assessment of corneal biomechanics in anisometropia using Scheimpflug technology","volume":"10","author":"Gao","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.ajo.2016.12.015","article-title":"Age-specific incidence and prevalence of keratoconus: a nationwide registration study","volume":"175","author":"Godefrooij","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/ICO.0000000000000408","article-title":"Global consensus on keratoconus and ectatic diseases","volume":"34","author":"Gomes","year":"2015","journal-title":"Cornea"},{"key":"B19","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/0002-9394(88)90726-x","article-title":"Keratoconus and ocular massage","volume":"106","author":"Gritz","year":"1988","journal-title":"Am. J. Ophthalmol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"712","DOI":"10.3928\/1081597x-20230831-04","article-title":"Eye rubbing in Chinese patients with keratoconus: a multicenter analysis","volume":"39","author":"Guo","year":"2023","journal-title":"J. Refract. Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1186\/s12886-023-02930-4","article-title":"Patient experience and repeatability of measurements made with the Pentacam HR in patients with keratoconus","volume":"23","author":"Gustafsson","year":"2023","journal-title":"BMC Ophthalmol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s12886-020-01551-5","article-title":"Assessment of the mechanical forces applied during eye rubbing","volume":"20","author":"Hafezi","year":"2020","journal-title":"BMC Ophthalmol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1097\/ico.0000000000002150","article-title":"The prevalence and risk factors for keratoconus: a systematic review and meta-analysis","volume":"39","author":"Hashemi","year":"2020","journal-title":"Cornea"},{"key":"B24","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/opo.12448","article-title":"High prevalence and familial aggregation of keratoconus in an Iranian rural population: a population-based study","volume":"38","author":"Hashemi","year":"2018","journal-title":"Ophthalmic Physiol. Opt."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1016\/j.jcrs.2019.03.017","article-title":"Comparison of eye-rubbing effect in keratoconic eyes and healthy eyes using Scheimpflug analysis and a dynamic bidirectional applanation device","volume":"45","author":"Henriquez","year":"2019","journal-title":"J. Cataract Refract. Surg."},{"key":"B26","doi-asserted-by":"publisher","first-page":"731","DOI":"10.3928\/1081597x-20200820-01","article-title":"Accelerated epithelium-off corneal cross-linking with high ultraviolet energy dose (7.2 J\/cm2) for progressive keratoconus: 2-year results in a Chinese population","volume":"36","author":"Kang","year":"2020","journal-title":"J. Refract. Surg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"7962","DOI":"10.3390\/ijerph19137962","article-title":"Effect of perceived stress on health-related quality of life among primary caregiving spouses of patients with severe dementia: the mediating role of depression and sleep quality","volume":"19","author":"Kim","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1111\/opo.12345","article-title":"Corneal biomechanics - a review","volume":"37","author":"Kling","year":"2017","journal-title":"Ophthalmic Physiol. Opt."},{"key":"B29","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.jcrs.2017.10.042","article-title":"Repeatability and reliability of ectasia display and topometric indices with the Scheimpflug system in normal and keratoconic eyes","volume":"44","author":"Kosekahya","year":"2018","journal-title":"J. Cataract Refract. Surg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"816","DOI":"10.3928\/1081597x-20210830-01","article-title":"Risk factors for progression of keratoconus and failure rate after corneal cross-linking","volume":"37","author":"Lenk","year":"2021","journal-title":"J. Refract. Surg."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1168503","DOI":"10.3389\/fbioe.2023.1168503","article-title":"Effect of eye rubbing on corneal biomechanical properties in myopia and emmetropia","volume":"11","author":"Li","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40662-020-00225-z","article-title":"Relationship between corneal biomechanical parameters and corneal sublayer thickness measured by Corvis ST and UHR-OCT in keratoconus and normal eyes","volume":"8","author":"Li","year":"2021","journal-title":"Eye Vis. Lond. Engl."},{"key":"B33","doi-asserted-by":"publisher","first-page":"574","DOI":"10.3758\/s13428-021-01578-6","article-title":"Two-level moderated mediation models with single-level data and new measures of effect sizes","volume":"54","author":"Liu","year":"2022","journal-title":"Behav. Res. Methods"},{"key":"B34","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1016\/j.survophthal.2017.06.009","article-title":"A review of keratoconus: diagnosis, pathophysiology, and genetics","volume":"62","author":"Mas Tur","year":"2017","journal-title":"Surv. Ophthalmol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1097\/TP.0000000000001281","article-title":"Changing indications in penetrating keratoplasty: a systematic review of 34 Years of global reporting","volume":"101","author":"Matthaei","year":"2017","journal-title":"Transplantation"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1152266","DOI":"10.3389\/fmed.2023.1152266","article-title":"Medium to long term follow up study of the efficacy of cessation of eye-rubbing to halt progression of keratoconus","volume":"10","author":"Mazharian","year":"2023","journal-title":"Front. Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"2431","DOI":"10.1007\/s00417-020-04771-z","article-title":"Incorrect sleeping position and eye rubbing in patients with unilateral or highly asymmetric keratoconus: a case-control study","volume":"258","author":"Mazharian","year":"2020","journal-title":"Graefes. Arch. Clin. Exp. Ophthalmol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1097\/OPX.0b013e318169287a","article-title":"The evidentiary significance of case reports: eye rubbing and keratoconus","volume":"85","author":"McMonnies","year":"2008","journal-title":"Optom. Vis. Sci."},{"key":"B39","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1097\/ICO.0b013e318198384f","article-title":"Mechanisms of rubbing-related corneal trauma in keratoconus","volume":"28","author":"McMonnies","year":"2009","journal-title":"Cornea"},{"key":"B40","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1111\/cxo.12343","article-title":"Eye rubbing type and prevalence including contact lens 'removal-relief' rubbing","volume":"99","author":"McMonnies","year":"2016","journal-title":"Clin. Exp. Optom."},{"key":"B41","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.clae.2012.01.001","article-title":"The role of heat in rubbing and massage-related corneal deformation","volume":"35","author":"McMonnies","year":"2012","journal-title":"Cont. Lens Anterior Eye"},{"key":"B42","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1136\/bjophthalmol-2020-316481","article-title":"Progression of keratoconus in children and adolescents","volume":"107","author":"Meyer","year":"2023","journal-title":"Br. J. Ophthalmol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1007\/s10792-022-02212-w","article-title":"Risk factors and severity of keratoconus on the East Coast of China","volume":"42","author":"Mou","year":"2022","journal-title":"Int. Ophthalmol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.18240\/ijo.2019.11.17","article-title":"The correlation between keratoconus and eye rubbing: a review","volume":"12","author":"Najmi","year":"2019","journal-title":"Int. J. Ophthalmol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.ajo.2021.05.009","article-title":"Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus: findings from a cochrane systematic review","volume":"229","author":"Ng","year":"2021","journal-title":"Am. J. Ophthalmol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3109\/09286586.2014.887735","article-title":"Ethnic variation in central corneal refractive power and steep cornea in Asians","volume":"21","author":"Pan","year":"2014","journal-title":"Ophthalmic Epidemiol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v048.i02","article-title":"Lavaan: an R package for structural equation modeling","volume":"48","author":"Rosseel","year":"2012","journal-title":"Stat. Softw."},{"key":"B48","doi-asserted-by":"publisher","first-page":"108328","DOI":"10.1016\/j.exer.2020.108328","article-title":"Genetics vs. chronic corneal mechanical trauma in the etiology of keratoconus","volume":"202","author":"Rabinowitz","year":"2021","journal-title":"Exp. Eye Res."},{"key":"B49","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1016\/j.ajo.2010.10.034","article-title":"The lifetime economic burden of keratoconus: a decision analysis using a markov model","volume":"151","author":"Rebenitsch","year":"2011","journal-title":"Am. J. Ophthalmol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"2032","DOI":"10.1186\/s12889-023-16937-5","article-title":"A high body mass index strengthens the association between the time of eye rubbing and keratoconus in a Chinese population: a case control study","volume":"23","author":"Ren","year":"","journal-title":"BMC Public Health"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1273500","DOI":"10.3389\/fbioe.2023.1273500","article-title":"Machine learning analysis with the comprehensive index of corneal tomographic and biomechanical parameters in detecting pediatric subclinical keratoconus","volume":"11","author":"Ren","year":"","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"266","DOI":"10.3928\/1081597x-20161221-03","article-title":"Introduction of two novel stiffness parameters and interpretation of air puff-induced biomechanical deformation parameters with a dynamic scheimpflug analyzer","volume":"33","author":"Roberts","year":"2017","journal-title":"J. Refract. Surg."},{"key":"B53","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1186\/s12886-022-02412-z","article-title":"Fourteen years follow-up of a stable unilateral Keratoconus: unique case report of clinical, tomographical and biomechanical stability","volume":"22","author":"Saad","year":"2022","journal-title":"BMC Ophthalmol."},{"key":"B54","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1007\/s00417-021-05081-8","article-title":"Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis","volume":"259","author":"Sahebjada","year":"2021","journal-title":"Graefes. Arch. Clin. Exp. Ophthalmol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1097\/ico.0000000000000460","article-title":"Does corneal collagen cross-linking reduce the need for keratoplasties in patients with keratoconus?","volume":"34","author":"Sandvik","year":"2015","journal-title":"Cornea"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e15658","DOI":"10.1097\/md.0000000000015658","article-title":"Corneal cross-linking for keratoconus caused by compulsive eye rubbing in patients with Tourette syndrome: three case reports","volume":"98","author":"Shinzawa","year":"2019","journal-title":"Medicine"},{"key":"B57","doi-asserted-by":"publisher","first-page":"610","DOI":"10.3928\/1081597X-20220715-03","article-title":"The impact of repetitive and prolonged eye rubbing on corneal biomechanics","volume":"38","author":"Torres-Netto","year":"2022","journal-title":"J. Refract. Surg."},{"key":"B58","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1007\/s00417-022-05881-6","article-title":"Reliability analysis of successive Corvis ST\u00ae measurements in keratoconus 2 years after accelerated corneal crosslinking compared to untreated keratoconus corneas","volume":"261","author":"Xanthopoulou","year":"2023","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"B59","doi-asserted-by":"publisher","first-page":"1163223","DOI":"10.3389\/fbioe.2023.1163223","article-title":"Comparison of bilateral differential characteristics of corneal biomechanics between keratoconus and normal eyes","volume":"11","author":"Xian","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B60","doi-asserted-by":"publisher","first-page":"e39313","DOI":"10.1371\/journal.pone.0039313","article-title":"Prevalence and associations of steep cornea\/keratoconus in Greater Beijing. The Beijing Eye Study","volume":"7","author":"Xu","year":"2012","journal-title":"PLoS One"},{"key":"B61","doi-asserted-by":"publisher","first-page":"999435","DOI":"10.3389\/fimmu.2022.999435","article-title":"Independent and interactive effects of eye rubbing and atopy on keratoconus","volume":"13","author":"Yang","year":"2022","journal-title":"Front. Immunol."},{"key":"B62","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s10654-024-01128-2","article-title":"The Chinese keratoconus (CKC) cohort study","volume":"39","author":"Yang","year":"","journal-title":"Eur. J. Epidemiol."},{"key":"B63","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2020\/6667507","article-title":"Association between corneal stiffness parameter at the first applanation and keratoconus severity","volume":"2020","author":"Yang","year":"2020","journal-title":"J. Ophthalmol."},{"key":"B64","doi-asserted-by":"publisher","first-page":"15379","DOI":"10.1038\/s41598-019-51502-4","article-title":"Repeatability and comparison of new Corvis ST parameters in normal and keratoconus eyes","volume":"9","author":"Yang","year":"2019","journal-title":"Sci. Rep."},{"key":"B65","doi-asserted-by":"publisher","first-page":"5508","DOI":"10.1038\/s41467-024-49645-8","article-title":"Development of graphitic carbon nitride quantum dots-based oxygen self-sufficient platforms for enhanced corneal crosslinking","volume":"15","author":"Yang","year":"","journal-title":"Nat. Commun."},{"key":"B66","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1111\/cxo.13001","article-title":"Keratometric indices for detecting the type of keratoconus: a combined discriminant analysis","volume":"103","author":"Yousefi","year":"2020","journal-title":"Clin. Exp. Optom."},{"key":"B67","doi-asserted-by":"publisher","first-page":"108286","DOI":"10.1016\/j.compbiomed.2024.108286","article-title":"CorNet: autonomous feature learning in raw Corvis ST data for keratoconus diagnosis via residual CNN approach","volume":"172","author":"Zhang","year":"2024","journal-title":"Comput. Biol. Med."},{"key":"B68","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1186\/s12888-023-04799-5","article-title":"A serial mediation model of social media addiction and college students\u2019 academic engagement: the role of sleep quality and fatigue","volume":"23","author":"Zhuang","year":"2023","journal-title":"BMC Psychiatry"}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1595671\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T01:28:40Z","timestamp":1750901320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2025.1595671\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,26]]},"references-count":68,"alternative-id":["10.3389\/fbioe.2025.1595671"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2025.1595671","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,26]]},"article-number":"1595671"}}