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 (<3Lmm; 68.4%), small epithelial defect (<3Lmm; 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.

The authors have declared no competing interest.

Funding support from the Medical Research Council Clinician Scientist Fellowship (UKRI2441) and Birmingham Health Partners (BHP) Clinician Scientist Fellowship.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the clinical governance team of both institutions as a clinical audit (BMEC Ref: 2444; QMC Ref: 19-265C) and was conducted in accordance with the tenets of Declaration of Helsinki. Ethics approval was not required as this clinical audit only involved retrospective study of anonymised data that were collected during the process of standard clinical care.

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Funding/support: DSJT acknowledges funding support from the Medical Research Council Clinician Scientist Fellowship (UKRI2441) and Birmingham Health Partners (BHP) Clinician Scientist Fellowship.

Conflict of interest: None

All data produced in the present study are available upon reasonable request to the authors