Risk factors of keratoconus in high school students in Trinidad and Tobago: a cross-sectional study

Background: Keratoconus (KC) is the most common form of keratectasia that is associated with impaired vision and reduced quality of life, especially in adolescents. This study aims to identify and assess the risk factors associated with KC among high school students in Trinidad and Tobago (T&T). Method: This was an institutional-based, cross-sectional study that utilized the Keratoconus (KC) Risk Investigative (KRIS) questionnaire to assess risk factors of KC among high school students in T&T. A multistage stratified cluster sampling technique was employed. The study examined established and non-established risk factors. Results: A total of 2084 students (mean age: 14 years, SD = 1.6, range 11–20) participated, with 674 (32.3%) reporting at least one risk factor of KC. The most prevalent risk factor overall was prolonged near-work (≥ 8 h/day, 59.8%), while exposure to sunlight (25%) was identified as the most established risk factor. Of those with risk factors, 60 (2.9%) had KC which was significantly associated with family history (χ² = 13.30, df = 1, p < 0.001) of KC, allergic diseases (χ² = 5.54, df = 1, p = 0.019), and light sensitivity (χ² = 10.18, df = 1, p = 0.001). Adjusted logistic regression showed that those with a family history of KC were 2.56 times more likely to develop the condition (95% CI: 1.11–5.93, p = 0.028), and those with light sensitivity had nearly double the odds (OR = 2.10, p = 0.007). Conclusion: This study underscores the role of genetic and environmental factors in KC development, highlighting the importance of near-work and light hypersensitivity. Early screening and targeted interventions are recommended, especially for individuals with a family history or related atopic conditions.