Behavioral and Sociodemographic Factors Associated with Vision-Related Quality of Life in Keratoconus: A Cross-Sectional Study in Riyadh, Saudi Arabia

Keratoconus is a progressive corneal ectasia that results in substantial visual impairment and imposes a significant functional and psychosocial burden on affected individuals. Despite evidence suggesting earlier onset and a potentially more aggressive disease course of keratoconus in Saudi populations, there is a significant lack of region-specific data evaluating vision-related quality of life (VRQoL) in Riyadh. This cross-sectional study conducted in Riyadh, Saudi Arabia, evaluated VRQoL in individuals with keratoconus using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Data were obtained from January to March 2025 through an online, structured, self-administered questionnaire. A total of 1007 participants were included, of whom 299 (29.7%) reported a diagnosis of keratoconus. The mean composite NEI-VFQ-25 score among participants with keratoconus was 61.0 ± 15.8, reflecting moderate impairment in VRQoL. Reduced VRQoL was significantly associated with eye-rubbing behavior, including both frequency (p = 0.027) and method (p = 0.026). The results highlight the importance of early detection and the relevance of eye-rubbing behavior in relation to reduced VRQoL, while supporting the need for longitudinal research to further clarify these associations.