{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T21:49:57Z","timestamp":1775684997454,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vision"],"abstract":"<jats:p>Aim: This study measured and evaluated the socioeconomic burden of people living with keratoconus in Saudi Arabia. Methods: This study employed a cross-sectional design, a Keratoconus Economic Burden Questionnaire, and a convenient sample of 89 keratoconus patients (58.4% male) drawn from multiple regions in Saudi Arabia. It was conducted using online surveys, and the data were analyzed using appropriate quantitative techniques. Results: The mean age and annual income of the participants were 33.24 (SD = 6.82) years and USD 9046.52 (SD = 16,866.48), respectively, with only 37% being employed for wages. Up to 94.4% needed glasses or contact lenses at least once a week, and 73.0% received care from optometrists. The condition forced 45.9% of the respondents to change careers or leisure activities, with a further 51.3% having to take time off work. The mean annual out-of-pocket expenses for buying and maintaining glasses or contact lenses, as well as traveling and accommodation for keratoconus-related treatment were USD 2341.76 (SD = 3053.09), with 48.32 incurring upwards of USD 3240 over the period. The treatment costs increased with disease duration, r(89) = 0.216, p &lt; 0.05. Regression results showed that the existence of comorbid eye disease, changing glasses at least once a year, and wearing either glasses or contact lenses at least once a week individually had statistically significant negative effects on the total annual keratoconus treatment costs, while disease duration, utilization of optometrists, and taking time off had a statistically significant increase on the total cost (p &lt; 0.05). Conclusion: With a prevalence rate of 1 in 375, progressive debilitation, and the lifetime nature of the disease, keratoconus is a critical public health concern in Saudi Arabia. The resulting visual impairment and discomfort, as well as both direct and indirect economic burdens, have considerable impacts on the patient\u2019s quality of life.<\/jats:p>","DOI":"10.3390\/vision7030052","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T11:23:03Z","timestamp":1691061783000},"page":"52","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Lifetime Expenditure in People with Keratoconus in Saudi Arabia"],"prefix":"10.3390","volume":"7","author":[{"given":"Saleha","family":"Al-Atawi","sequence":"first","affiliation":[{"name":"Optometry Department, Faculty of Applied Medical Science, Al Baha University, Al Baha 4781, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al Baha University, Al Baha 4781, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2325-7688","authenticated-orcid":false,"given":"Khaled","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Optometry Department, King Fahad Armed Hospital, Jeddah 23311, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/ceo.13704","article-title":"Economic impact of keratoconus using a health expenditure questionnaire: A patient perspective","volume":"48","author":"Chan","year":"2020","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kumanomido, T., Kamiya, K., Takahashi, M., Tsujisawa, T., Hayakawa, H., Ando, W., Utsumi, Y., and Shoji, N. (2022). Clinical evaluation of flat peripheral curve design with aspherical-curve and multi-curve hard contact lenses for keratoconus. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0263506"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7803029","DOI":"10.1155\/2017\/7803029","article-title":"Molecular and Histopathological Changes Associated with Keratoconus","volume":"2017","author":"Khaled","year":"2017","journal-title":"BioMed Res. Int."},{"key":"ref_4","doi-asserted-by":"crossref","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":"ref_5","doi-asserted-by":"crossref","first-page":"3191","DOI":"10.1007\/s10792-022-02319-0","article-title":"Prevalence of keratoconus in refractive surgery practice population in North Macedonia","volume":"42","author":"Gilevska","year":"2022","journal-title":"Int. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"764","DOI":"10.3928\/1081-597X-20061001-06","article-title":"INTACS Inserts Using the Femtosecond Laser Compared to the Mechanical Spreader in the Treatment of Keratoconus","volume":"22","author":"Rabinowitz","year":"2006","journal-title":"J. Refract. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jcrs.2009.07.040","article-title":"Intrastromal corneal ring segment SK implantation for moderate to severe keratoconus","volume":"36","author":"Sansanayudh","year":"2010","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1007\/s10792-018-0994-z","article-title":"Indications and techniques of corneal transplantation in a referral center in Colombia, South America (2012\u20132016)","volume":"39","author":"Galvis","year":"2019","journal-title":"Int. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"OED.S38364","DOI":"10.4137\/OED.S38364","article-title":"Corneal Cross-Linking (with a Partial Deepithelization) in Keratoconus with Five Years of Follow-Up","volume":"8","author":"Galvis","year":"2016","journal-title":"Ophthalmol. Eye Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.ophtha.2017.03.019","article-title":"Corneal Collagen Cross-Linking in the Management of Keratoconus in Canada","volume":"124","author":"Leung","year":"2017","journal-title":"Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1080\/13696998.2020.1851556","article-title":"Corneal cross-linking versus conventional management for keratoconus: A lifetime economic model","volume":"24","author":"Lindstrom","year":"2021","journal-title":"J. Med. Econ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5005\/jp-journals-10025-1070","article-title":"Prevalence of Keratoconus among Young Arab students in Israel","volume":"3","author":"Barbara","year":"2014","journal-title":"Int. J. Keratoconus Ectatic Corneal Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1136\/bjophthalmol-2017-311391","article-title":"Prevalence of keratoconus in paediatric patients in Riyadh, Saudi Arabia","volume":"102","author":"Hafezi","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"241","DOI":"10.2174\/1874364101711010241","article-title":"Contact Lenses for Keratoconus- Current Practice","volume":"11","author":"Moschos","year":"2017","journal-title":"Open Ophthalmol. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.18240\/ijo.2020.07.17","article-title":"Effect of rigid gas permeable contact lens on keratoconus progression: A review","volume":"13","author":"Zhang","year":"2020","journal-title":"Int. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1097\/ICO.0000000000000499","article-title":"Inflammation in Keratoconus","volume":"34","author":"Galvis","year":"2015","journal-title":"Cornea"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ajo.2017.10.022","article-title":"Scleral Lenses Reduce the Need for Corneal Transplants in Severe Keratoconus","volume":"185","author":"Koppen","year":"2018","journal-title":"Am. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.sjopt.2017.11.003","article-title":"Prevalence of keratoconus among patients seeking laser vision correction in Taif area of Saudi Arabia","volume":"32","author":"Althomali","year":"2018","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6153","DOI":"10.4103\/jfmpc.jfmpc_1212_20","article-title":"Awareness level of general population regarding keratoconus in Aseer region, Southern of Saudi Arabia","volume":"9","author":"Alshamrani","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s40123-018-0144-8","article-title":"Genetic Aspects of Keratoconus: A Literature Review Exploring Potential Genetic Contributions and Possible Genetic Relationships with Comorbidities","volume":"7","author":"Loukovitis","year":"2018","journal-title":"Ophthalmol. Ther."},{"key":"ref_21","unstructured":"David, B. (2020). Resnik: What Is Ethics in Research & Why Is It Important?, Springer. [2nd ed.]."},{"key":"ref_22","unstructured":"(2022, July 10). The World Bank: Saudi Arabia. Available online: https:\/\/datacommons.org\/place\/country\/SAU?utm_medium=explore&mprop=amount&popt=EconomicActivity&cpv=activitySource%2CGrossDomesticProduction&hl=en#."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1038\/eye.2015.151","article-title":"Cost effectiveness of collagen crosslinking for progressive keratoconus in the UK NHS","volume":"29","author":"Salmon","year":"2015","journal-title":"Eye"},{"key":"ref_24","doi-asserted-by":"crossref","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":"ref_25","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1136\/bjo.2005.074955","article-title":"Incidence and severity of keratoconus in Asir province, Saudi Arabia","volume":"89","author":"Assiri","year":"2005","journal-title":"Br. J. Ophthalmol."},{"key":"ref_26","unstructured":"Alvaro, J., and Rodrigues, P.F. (2023). Keratoconus, Elsevier."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.ajo.2009.06.024","article-title":"Prevalence and Associations of Keratoconus in Rural Maharashtra in Central India: The Central India Eye and Medical Study","volume":"148","author":"Jonas","year":"2009","journal-title":"Am. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jcjo.2013.02.001","article-title":"Intacs with or without same-day corneal collagen cross-linking to treat corneal ectasia","volume":"48","author":"Legare","year":"2013","journal-title":"Can. J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/00004397-200604630-00009","article-title":"INTACS for Keratoconus","volume":"46","author":"Rabinowitz","year":"2006","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/OPX.0000000000001578","article-title":"Safety and Efficacy of Scleral Lenses for Keratoconus","volume":"97","author":"Fuller","year":"2020","journal-title":"Optom. Vis. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4103\/0301-4738.151468","article-title":"Current review and a simplified \u2018five-point management algorithm\u2019 for keratoconus","volume":"63","author":"Arora","year":"2015","journal-title":"Indian J. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"12970","DOI":"10.1038\/s41598-021-92346-1","article-title":"Quality of Life in Keratoconus: Evaluation with Keratoconus Outcomes Specific Questionnaire (KORQ)","volume":"11","author":"Pinto","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_33","first-page":"e11932","article-title":"Depression Among Keratoconus Patients in Saudi Arabia","volume":"12","author":"Alsaad","year":"2020","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1038\/s41433-020-0991-0","article-title":"Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients","volume":"35","author":"Mokhles","year":"2021","journal-title":"Eye"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.survophthal.2015.02.004","article-title":"Treatment options for advanced keratoconus: A review","volume":"60","author":"Parker","year":"2015","journal-title":"Surv. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101518","DOI":"10.1016\/j.clae.2021.101518","article-title":"Referral pattern and co-management of keratoconus patients in primary eye care: A survey of three European countries","volume":"45","author":"Rahmani","year":"2022","journal-title":"Contact Lens Anterior Eye"}],"container-title":["Vision"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5150\/7\/3\/52\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:25:25Z","timestamp":1760127925000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5150\/7\/3\/52"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,3]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["vision7030052"],"URL":"https:\/\/doi.org\/10.3390\/vision7030052","relation":{},"ISSN":["2411-5150"],"issn-type":[{"value":"2411-5150","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,3]]}}}