Fungal keratitis prevalence twice as high in rural versus nonrural areas

Fungal keratitis prevalence appears to be twice as high in rural versus nonrural areas, according to a research letter published in JAMA Ophthalmology.

Kaitlin Benedict, M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues estimated fungal keratitis prevalence among commercially insured U.S. patients. The analysis included Merative MarketScan Commercial and Medicare Databases claims data (Jan. 1, 2016, through Jan. 31, 2023).

The researchers identified 870,810 individuals with continuous enrollment and a diagnostic code for keratitis. Of these, 0.8 percent had a natamycin prescription. Overall fungal keratitis prevalence was 1.8 per 100,000 enrollees but was higher among males (1.9), adults aged 65 years and older (6.6), and patients living in the South (2.7) and rural areas (3.6).

Corneal ulcer was the most common associated condition (94.2 percent). Common medications included ophthalmic antibiotic (80.7 percent) or corticosteroid (43.5 percent). More than one in seven (15.0 percent) had contact lens-associated diagnostic codes. Nearly three-quarters (74.9 percent) underwent diagnostic testing, and 10.6 percent received a corneal transplant.

"Given the potential for poor vision outcomes and the possibility of climate change-associated geographic expansion of pathogenic fungi, monitoring fungal keratitis trends, improving rural eye care access, and promoting early diagnosis and treatment are crucial," the authors write.