Socioeconomic deprivation not linked to presentation or outcomes in UK bacterial keratitis cohort

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medRxiv Published April 13, 2026 Medically reviewed April 25, 2026 Study authors: Javed, K. M. A. A.; Ozturk, B.; Anwar, S.; Butt, G.; Low, L.; Said, D. G.; Dua, H. S.; Rauz, S.; Tin… DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Note: In this UK cohort, deprivation was not associated with bacterial keratitis presentation or visual outcomes.

This retrospective multicentre cohort study analyzed 320 patients with bacterial keratitis presenting to two UK tertiary ophthalmic centres. The exposure was socioeconomic deprivation, grouped into quintiles using the 2019 English Index of Multiple Deprivation (IMD), with Q1 representing the most deprived and Q5 the least deprived. The primary aim was to assess the impact of deprivation on clinical presentation and outcomes.

The study found no significant differences (p>0.05) across IMD quintiles for multiple key measures: presenting corrected distance visual acuity (CDVA), time to presentation, clinical severity at presentation, admission rates, microbiological profile, or need for surgical intervention. Final CDVA improved significantly from a mean of 1.10 (+/-1.01) logMAR to 0.75 (+/-0.96) logMAR (p<0.001). IMD was not associated with final CDVA; predictors of poorer final vision were worse presenting CDVA, increasing age, and Gram-positive organisms.

No specific safety or tolerability data were reported. Key limitations include the retrospective, observational design, which cannot establish causality, and the setting within a nationalized healthcare system (the UK NHS), which may limit generalizability to other healthcare models with different access barriers. The findings, while negative for an association, are specific to the measured management pathways and do not rule out other social determinants of health affecting corneal infection risk or care.

Study Details

Study typeCohort

Sample sizen = 320

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

Background/Aims: To evaluate the impact of socioeconomic deprivation on clinical presentation and outcomes of bacterial keratitis (BK) in the United Kingdom. Methods: A retrospective multicentre cohort study of 320 patients with BK presenting to two UK tertiary ophthalmic centres. Demographic, clinical and microbiological data were extracted from electronic health records. Socioeconomic status was assigned using residential postcodes mapped to the 2019 English Index of Multiple Deprivation (IMD) and grouped into quintiles (Q1 most deprived; Q5 least deprived). Presenting severity and outcomes were compared across IMD quintiles. Results: The mean age was 54.0{+/-}20.9 years; 50.6% were male and 83.4% were White. Mean presenting CDVA was 1.10{+/-}1.01 logMAR and time to presentation was a median of 3 days (IQR 1-6). Most cases had a small infiltrate (<3 mm; 68.4%), small epithelial defect (<3 mm; 63.4%) and no hypopyon (72.5%). Hospitalisation was required in 50.0%, and 17.5% underwent surgery. Culture positivity was 36.3%. There were no significant differences in presenting CDVA, time to presentation, clinical severity, admission, microbiological profile, surgical intervention or final CDVA across IMD quintiles (all p>0.05). Final CDVA improved to 0.75{+/-}0.96 logMAR (p<0.001). On multivariable analysis, poorer final CDVA was associated with worse presenting CDVA, increasing age and Gram-positive organisms, but not IMD. Conclusion: Socioeconomic deprivation did not influence the clinical presentation or outcomes in BK. Clinical severity at presentation and microbiological profile were the principal determinants of outcome. In this acute, painful sight-threatening condition, deprivation-related disparities may be attenuated by prompt presentation and universal access to emergency ophthalmic care.