Purpose To determine the association between sociodemographic factors, visual acuity (VA) and corneal topography (Kmax and K2) following collagen cross-linking (CXL) in a cohort of ethnically-diverse keratoconus patients.   Methods The records of 88 keratoconus patients who underwent CXL between January 2021 and December 2022 at King's College Hospital were examined. Data on age, sex, ethnicity, deprivation deciles, significant postoperative complications, pre and postoperative best VA (BVA), Kmax and K2 were extracted. Univariate Kaplan-Meier and multivariate cox-regression survival analyses were used to determine outcomes of BVA stability, Kmax stability K2 stability and composite Kmax/K2 stability at 52 weeks after CXL.   Results At 52 weeks, there was an 81.1% (95% confidence interval (CI): 71.2%–87.6%) probability of BVA stability and 80.7% (67.4%–88.5%) probability of Kmax/K2 stability. Multivariate analyses showed significant associations (p<0.05) between Kmax/K2 stability and 'other' ethnicity but not other sociodemographic factors.   Conclusion CXL is associated with the stabilisation of vision and corneal topography in the majority of eyes. One significant association was found between other ethnicity and corneal topographical outcomes after CXL, however, no other significant associations were found between the majority of sociodemographic or economic factors with VA or corneal topographical outcomes after CXL. This suggests CXL results in good functional and anatomical outcomes independent of sociodemographic status.

The authors have declared no competing interest.

The author(s) received no specific funding for this work.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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

This study was conducted as an audit of the local outcomes after CXL for KC using the published literature [22] as the gold standard. The study used anonymised retrospective data and, as an audit, was exempt from research ethics committee approval. The audit was registered and approved by the Ophthalmology Care Group Audit Lead at King's College Hospital on the 23rd October 2023 and the audit ID was AS008.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Approvals to share the dataset is not covered in the audit approval process, the raw data therefore cannot be shared. Programming code is included in the Supporting Information.