Abstract
<title>Abstract</title> <p> Background To investigate the prevalence and risk factors of keratoconus [KC] among Omani school children. Methods The study employed a cross-sectional, population based, descriptive design. A cohort of school students, aged 9 to 18 years from the Al Buraimi Governorate of Sultanate of Oman underwent comprehensive ocular assessments, including auto-kerato-refractometry (ARK), retinoscopy, and corneal topography. A binary logistic regression analysis was performed to identify the independent predictors of KC. Results A total of 733 students participated (mean age 13.95 ± 2.19 years) and 67.4% were males. Twelve participants (1.6%) met criteria for keratoconus (KC), and 5.0% were classified as keratoconus suspect (KCS). Regression analysis identified the scissor reflex as the strongest predictor of both KCS (OR = 848.52, 95% CI: 168.03–4284.93; <italic>p</italic> < 0.001) and KC (OR = 120.65, 95% CI: 16.98–857.25; <italic>p</italic> < 0.001). Among KC cases, frequent eye rubbing (OR = 13.60; <italic>p</italic> = 0.020) and parental consanguinity (OR = 21.77; <italic>p</italic> = 0.021) were also significant risk factors. Conclusion Keratoconus prevalence in this study aligns with regional reports, confirming a higher burden than in Western populations. Consanguinity as a significant predictor underscores the need for genetic counseling and risk awareness, and the strong predictive value of the scissor reflex supports the use of retinoscopy in screening. </p>