Potentially, it may prevent unnecessary treatments, reduce exposure to treatment risks, and improve the cost effectiveness of crosslinking. Compared with the conventional maximum keratometry criterion of more than 1.0 diopter, the DUCK score may better select patients who might benefit from crosslinking treatment. The DUCK score appears to better identify eyes that were duly withheld treatment by 35% (95% CI, 22%-49%).Ĭonclusions and Relevance These results provide validation of the DUCK score as a tool to determine whether a crosslinking treatment might be warranted. Adhering to the DUCK score, rather than maximum keratometry, was associated with a reduction in overall treatment rate by 23% (95% CI, 18%-30%), without increasing the risk of disease progression (ie, the rate of progression for both groups was equal ☐%). Baseline patient characteristics of the discovery cohort and the validation cohort were comparable in terms of age (mean, 26.8 years vs 26.3 ), sex (216 of 332 vs 123 of 172 men), and maximum keratometry (mean, 53.5 vs 52.7 ). Results A total of 504 eyes of 388 patients were available for analysis on disease progression in the course of 12 and 24 months. Main Outcomes and Measures Overall treatment rate reduction and the duly withheld treatment rate. Sensitivity analyses and intraitem correlations were performed. ![]() We compared the DUCK scores to the conventional 1.0-diopter increase in maximum keratometry criterion, within the last 12 months, in a longitudinal discovery and a validation cohort. The DUCK score is derived by scoring 0 to 2 points per item, and cutoffs were determined by clinical experience. Interventions The Dutch Crosslinking for Keratoconus (DUCK) score is based on changes in 5 clinical parameters that are routinely assessed: age, visual acuity, refraction error, keratometry, and subjective patient experience. Patients with keratoconus referred between January 1, 2012, and June 30, 2014, with 2-year follow-up were included. Objective To assess and validate a novel clinical scoring system as an easy-to-use assessment tool for crosslinking treatment in patients with keratoconus.ĭesign, Setting, and Participants Prospective cohort study at 2 academic treatment centers. Currently, there is no consensus which parameters should be used to define progression. Importance Defining keratoconus progression is fundamental in clinical decision making because crosslinking treatments are indicated when the disease is considered progressive. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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