keratoconus progression criteria

While numerous articles have been written on normal values generated by Scheimpflug imaging or OCT [48, 49, 54, 55], there are no available data on anterior and posterior curvature from the 3.0 mm zone centered on the thinnest point as these parameters have not been previously described. An example of subclinical keratoconus. Posteriorly, normal eyes showed an average change in apex and maximum elevation of 2.86±1.9µm and 2.27±1.1µm. The “Belin ABCD” grading system has been incorporated in the OCULUS Pentacam software version 6.08r16 as part of the Topometric/Keratoconus Grading Display (Fig. 1984;28:293–322. Corneal elevation indices in normal and keratoconic eyes. A. Qureshi, “Keratoconus diagnosis and progression criteria based on multiple imaging devices,” The Annual ASCRS and ASOA Symposium and Congress, 2014. Transepithelial accelerated versus conventional corneal collagen crosslinking in patients with keratoconus: a comparative study. 2012;53(2):927–35. Objective imaging Quantitative and Qualitative Keratoconus Diagnosis and Progression Criteria G. Asimellis, PhD, A. John Kanellopoulos, MD R. Ambrosio, MD, G. Pamel, MD Course Description: Will present methodology A number of other parameters or systems have been advocated to document progression [22, 25, 26, 34–40]. criteria in making an early diagnosis and assessing pro - gression in keratoconus patients. Br J Ophthalmol. Suzuki M, Amano S, Honda N, Usui T, Yamagami S, Oshika T. Longitudinal changes in corneal irregular astigmatism and visual acuity in eyes with keratoconus. He or she may conduct other tests to determine more details regarding the shape of your cornea. View at: Google Scholar R. L. Epstein and G. L. Epstein, “On keratoconus incidence in prospective refractive surgery patients,” Scripta Medica (Banja Luka) , vol. Among the topographic indices used, simulated K (SimK), astigmatism, irregularity index of 3 … Excluding this zone from the standard 8 mm BFS results in a reference surface that closely mimics the more normal portions of the cornea. Researchers in the Netherlands have revealed the Dutch Crosslinking for Keratoconus (DUCK) score may better identify patients with progressive keratoconus. Oshika T, Tanabe T, Tomidokoro A, Amano S. Progression of keratoconus assessed by fourier analysis of videokeratography data. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. Keratoconus and Ectatic… Klin Monatsbl Augenheilkd 2020; 237: 740–744 This document was downloaded for personal use only. Nottingham J. Rabinowitz YS, Nesburn AB, McDonnell PJ. criteria in mak ing an ea rly diagnosis and assessi ng pro-gression in keratoconus patients. Barbara R, Castillo JH, Hanna R, Berkowitz E, Tiosano B, Barbara A. Keratoconus Expert Meeting, London, 2014. Klin Monbl Augenheilkd. Google Scholar. Occurrence of keratoconus is pan-ethnic with reported prevalence ranging widely from 1:400 to about 1:8000, higher in Asian than Western populations. Expanding the cone location and magnitude index to include corneal thickness and posterior surface information for the detection of keratoconus. Comparison of multimetric D index with keratometric, pachymetric, and posterior elevation parameters in diagnosing subclinical keratoconus in fellow eyes of asymmetric keratoconus patients. 7). Part of Keratoconus. 1998;114:38–40. London: J Churchill; 1854. 2012;1(1):31–5. It displays the elevation data against the commonly used best-fit-sphere (BFS) taken from the central 8.0 mm zone, but also uses a newly developed reference surface called the “Enhanced Reference Surface.”. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values. In addition, Koller et al. 2002;109(2):339–42. Ophthalmology. Corneal thinning typically occurs inferotemporal as well as central, although superior thinning has also been described [4]. KPI was defined by logistic regression and consisted of a Pachymin coefficient of -0.78 (p=0.001), a maximum elevation of back surface coefficient of 0.27 and coefficient of corneal curvature at the zone 3 mm away from the thinnest point on the posterior corneal surface of -12.44 (both p<0.001). 2007;51(4):265–9. The newly described ABCD keratoconus grading system uses the anterior and posterior radius of curvature taken from the 3 mm zone centered on the thinnest point (“A” for anterior, “B” for back surface) and the corneal thickness at the thinnest point (“C” for corneal thickness) as well as best corrected distance visual acuity (“D” for distance visual acuity). This may result in blurry vision, double vision, nearsightedness, irregular astigmatism, and light sensitivity leading to poor quality-of-life. The cornea is substantially thinned with a prominent posterior ectasia in spite of a normal anterior surface (BAD display, Oculus Pentacam). J Refract Surg. Keratoconus eyes showed anterior apex and maximum elevation changes of 20.4±23.1µm and 20.9±21.9µm. Keratoconus was first described in detail in 1854 as a chronic, non-inflammatory ectasia of the cornea. Diagnosis of corneal ectasia Must be able to complete all study visits. Criteria that showed the greatest agreement with progression to corneal graft surgery were used to evaluate each eye with keratoconus and the factors associated with topographic progression were investigated. Each technician imaged each patient three times for each time period for a total of 27 images per patient, 135 images total. Int J Kerat Ect Cor Dis. [Epub ahead of print]. J Cataract Refract Surg. MUCH ADO ABOUT KERATOCONUS TERMINOLOGY The currently used phrases « forme fruste », « early subclinical » or « keratoconus suspect » in keratoconus terminology is fraught with confusion. Additionally, while using cases of subclinical keratoconus would be germane, there still is no universal agreement on what constitutes subclinical disease, with many investigators still utilizing Amsler-Krumeich and relying on anterior surface topography [10, 23]. See rights and permissions.,, Weed KH, McGhee CN, Mac Ewen CJ. Article  Revisiting keratoconus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases Anastasios John Kanellopoulos1,2 George Asimellis1 Eye Institute, Athens, Greece; 2New York University School of Medicine, New York, NY, USA Correspondence: Anastasios John Kanellopoulos … Google Scholar. 22 In a longitudinal study, Li et al identified videokeratographic indices predictive . J Cataract Refract Surg. Velázquez JS, Cavas F, Piñero DP, Cañavate FJF, Alio Del Barrio J, Alio JL. Choi JA, Kim MS. PubMed Central  Jpn J Ophthalmol. Keratoconus. The two variables with the highest Youden Index in the ROC analysis were D-index and KPI: D-index had a cut-off of 0.4175 (70.6% sensitivity) and Youden Index of 0.606., DOI: Comparison of variables measured with a Scheimpflug device for evaluation of progression and detection of keratoconus. Google Scholar. Kmax, however, has been acknowledged as a poor parameter for both progression and crosslinking efficacy [31–35]. The corneal thickness map shows a thinnest point that is displaced inferiorly and the posterior elevation reveals a prominent posterior island in an eye that has a normal anterior surface (Oculus Pentacam). 2012;28(12):890–4. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. As opposed to excluding the 3.0 to 4.0 mm zone to normalize the reference surface, we employed the exclusion zone centered on the thinnest point as this area more globally represents the ectatic region than a single point parameter such as Kmax or maximal elevation. Our goal was to determine the quantitative values and to access their suitability as progression determinants. The panel defined progression by a consistent change in at least two of the following parameters: steepening of the anterior corneal surface, steepening of the posterior corneal surface, and thinning and/or thinning or changes in the pachymetric rate of change. 2006;32(8):1281–7. A new method for grading the severity of keratoconus: the Keratoconus Severity Score (KSS). This would be particularly true for decentered cones. Orucoglu F, Toker E. Comparative analysis of anterior segment parameters in normal and keratoconus eyes generated by scheimpflug tomography. 2013;120(12):2403–12. Revisiting keratoconus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases Purpose: To survey the standard keratoconus grading scale (Pentacam®-derived Amsler-Krumeich stages) compared to corneal irregularity indices and best spectacle-corrected distance visual acuity (CDVA). Kamiya K, Ishii R, Shimizu K, Igarashi A. CAS  Defining Keratoconus Progression With our ability to stop the progression of keratoconus with treatments such as corneal cross linking it becomes that much more important to come to some consensus about defining progression of the disease. ferent criteria for progression have been used, including clinical progression to penetrating keratoplasty [3-12]. Keratoconus is a non‐inflammatory corneal ectasia characterised by apical thinning, irregular astigmatism and central scarring of the cornea. Conclusions: Measuring corneal thickness change at the thinnest point should be a more sensitive indicator of progression than apical pachymetry. Others have looked at visual acuity, manifest refraction, and central corneal thickness as measures to follow ectatic progression, but these have also been found to be unreliable, and do not correlate well with severity of keratoconus [35–37]. NIH J Cataract Refract Surg. Assessment of the tomographic values in keratoconic eyes after collagen crosslinking procedure. Epub 2015 Feb 21. J Cataract Refract Surg. 2013;7:1539–48. The enhanced reference surface works because the exclusion zone centered on the thinnest point incorporates the major ectatic region. Therefore, we used parameters that took several variables into consideration (eg, D-index, index of surface variance, index for height asymmetry, KPI). Future work, however, will evaluate patients with mild to moderate disease. Article  The limitation of the study is that the confidence intervals were determined on normal subjects and it is highly likely that measurement variability would be greater in ectatic corneas, though these values probably reflect early disease fairly well. J Cataract Refract Surg. CLMI: the cone location and magnitude index. Results Variables used for keratoconus detection showed a weak correlation with each other (eg, correlation r=0.245 between RPImin and Kmax, p<0.001). Fourier-domain optical coherence tomography imaging in keratoconus: a corneal structural classification. Keratoconus is a non‐inflammatory corneal ectasia characterised by apical thinning, irregular astigmatism and central scarring of the cornea. Computerized videokeratography is also useful in detecting early keratoconus and allows following its progression. Keywords: keratoconus; progression; videokeratography 1. Med Arch. Schematic of axial topography including a sample topography of the left eye. The estimated preva-lence of keratoconus is about 50e230/100,000 in the general population (Rabinowitz, 1998). Usually both eyes are affected. 1993;100:181–6. More than 50 gene loci and 200 variants are associated with keratoconus, some through association studies with quantitative traits of cornea … Changes to the anterior and posterior BFS taken from the 3.0 mm zone centered on the thinnest point should also be a more sensitive indicator of cone progression. Here, the normal patient variation is probably more applicable and more closely approximates very early disease than values determined from known cases of keratoconus. 2005;28:177–9. McMahon TT, Szczotka-Flynn L, Barr JT, Anderson RJ, Slaughter ME, Lass JH, et al. Each technician was instructed to acquire three images with an acceptable quality check (machine verification of an acceptable image). Gilani F, Cortese M, Ambrósio Jr RR, Lopes B, Ramos I, Harvey EM, et al. CAS  1986;101:267–73. COVID-19 is an emerging, rapidly evolving situation. PubMed  1, p. 32, 2013. Neuhann S, Schuh A, Krause D, Liegl R, Schmelter V, Kreutzer T, Mayer WJ, Kohnen T, Priglinger S, Shajari M. Sci Rep. 2020 Nov 9;10(1):19308. doi: 10.1038/s41598-020-76020-6. looked at spherical power, regular astigmatism, decentration, and higher order irregular astigmatism as a means of quantifying advancement of ectasia [39]. eCollection 2019. With this information, both corneal thickness and anterior chamber depth can be computed. Department of Ophthalmology & Vision Science, University of Arizona, Tucson, AZ, USA, University of Arizona, University Information Technology Services, Tucson, AZ, USA, You can also search for this author in To develop a criterion for determining the topographic progression of keratoconus and to analyze the prognostic factors of progression. Progression of keratoconus by longitudinal assessment with corneal topography. Specifically, Oshika et al. The enhanced reference surface was not only qualitatively useful in visualizing subtle or early ectatic change, but the elevation difference between a standard BFS and the enhanced reference surface also proved to be highly significant quantitatively in separating normal eyes from those with ectatic change [50]. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of pediatric corneal collagen cross-linking in children and adolescents. The criteria used to define keratoconus progression were satisfactory when compared to inter-session reliability of corneal parameters. As earlier noted, according to Global Consensus on Keratoconus and Ectatic Diseases (2015), there is no consistent or clear definition of ectasia progression [23]. Kuechler SJ(1), Tappeiner C, Epstein D, Frueh BE. (P<.0001). Keratoconus was deemed to be progressive if there was a subjective deterioration in vision and at least one of the following criteria were met over two consecutive visits: at least one dioptre (D) increase in the Ks value derived from corneal topography or an increase of 1.00 D or more change in refractive astigmatism. Methods Eligibility Criteria for Considering Studies for Review Inclusion Criteria . 2019 Mar 1;13:445-452. doi: 10.2147/OPTH.S189183. For each of these parameters (corneal thickness, ARC, PRC) a decrease would be indicative of progression. 2016;233:701-707 2. This is actually not the case for ectatic corneas where the reference surface (typically a BFS taken from the central 8 mm zone) incorporates all data from the specified zone including normal and abnormal cornea [51]. In order to determine the suitability of the above three parameters as potential progression determinants, both a pooled variance estimate and a one-sided confidence interval were computed using both SPSS version 23 (IBM Corp., Armonk, NY) and STATA 13 (StataCorp LP, College Station, TX). 5). 2013;2(3):95–103. CXL has the potential to alter the natural course of the disease and, if implemented early enough in the disease process, to prevent visual loss. The size of the exclusion zone had to be large enough to have more global representation than single parameters such as Kmax, but if the area was too large, then more “normal” cornea would be included; for displaced cones, far peripheral or extrapolated data would be incorporated. 2019 Nov 19;2019:1748579. doi: 10.1155/2019/1748579. Tests to diagnose keratoconus include: 1. Cornea. Am J Ophthalmol. Round and oval cones in keratoconus. Exclusion Criteria: Prior corneal surgery in keratoconus A table listing the criteria for keratoconus progression in previous studies was generated. Li X, Yang H, Rabinowitz YS. 2014 Oct;111(10):920-6. doi: 10.1007/s00347-013-2962-3. It is the most common primary ectasia, and is characterized by corneal steepening, visual distortion, apical corneal thinning, and central corneal scarring [1–3]. 1994;35:2749–57. Pinheiro-Costa J, Correia PJ, Pinto JV, Alves H, Torrão L, Moreira R, Falcão M, Carneiro Â, Madeira MD, Falcão-Reis F. Sci Rep. 2020 Nov 17;10(1):19938. doi: 10.1038/s41598-020-77122-x. PubMed  Cut-off for KPI was -0.78196 (84.7% sensitivity) and a Youden Index of 0.747; both 90% specificity. The study protocol was approved by the University of Arizona (Tucson, Arizona) Institutional Review Board. Increased choroidal thickness is not a disease progression marker in keratoconus. conus progression consisting of several criteria (as seen below) and analysed the behaviour of the variables D-index, index of surface variance (ISV), index for height asymmetry (IHA), kera-toconus index front surface elevation difference; Dp, deviation of pachymetric progression; Dt, deviation (KI) and keratoconus progression index (KPI) J Adv Res. Mahmoud AM, Roberts CJ, Lembach RG, Twa MD, Herderick EE, McMahon TT. Article  The monitoring pathway at Moorfields Eye Hospital Caption: Figure 3. 4). the standard criteria that consider the presence of the following signs: anterior corneal topographic asymmetric bowtie pattern, KISA 100, and one or more biomicroscopic keratoconus signs, such as Fleischer ring, significant corneal thinning, Vogt striae, con- These values were obtained by imaging five normal patients using three different technicians on three separate days. © 2021 BioMed Central Ltd unless otherwise stated. There's simply very little on OrthoK and keratoconus in the literature. Several features of this site will not function whilst javascript is disabled. Eye refraction. The only abnormality seen here (BAD display) is a mild abnormality in the pachymetric progression (Oculus Pentacam), The additional information available from anterior segment tomographic devices has led to the development of various refractive surgery screening programs. RESULTS: There was a significant, albeit moderate, correlation between the change in Kmax between T0 and T-1 and the change in both A (rho=0.391) and B values (rho= 0.339). Clin Ophthalmol. Exclusion criteria included past ocular surgery, recent rigid contact lens wear, and corneal scarring. Ophthalmology. 2013;61(8):401–6. 1 This definition remains unequivocal; however, defining the progression and the threshold for therapeutic and surgical intervention in patients with keratoconus, particularly those currently under observation, presents a considerable ongoing … J Cataract Refract Surg. [14, 42, 46–48]. Would you like email updates of new search results? Keratoconus and related non- inflammatory corneal thinning disorders. 22 In a longitudinal study, Li et al identified videokeratographic indices predictive for the development of keratoconus in the normal eye of 2006;25:794–800. This article describes the statistical analysis plan for this trial as an update to the published protocol. Belin MW, Khachikian SS, Ambrósio Jr R, Salomão M. Keratoconus/ectasia detection with the oculus pentacam: Belin/Ambrósio enhanced ectasia display. 1) [33]. Its genetics is complex with undefined pattern of inheritance. KERALINK is a randomised controlled, observer-masked, multicentre trial in progressive keratoconus comparing epithelium-off CXL with standard care, including spectacles or contact lenses … Keratoconus is relatively uncommon with a reported annual incidence of 2 per 100,000 and prevalence of 54.5 per 100,000, though rates vary greatly in different geographic regions [5, 6, 7]. Wittig-silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR. To generate this new reference surface, a smaller diameter optical zone (exclusion zone) centered on the thinnest portion of the cornea is excluded from the 8.0 mm optical zone used for the standard BFS computation. This steepened BFS will minimize the elevation difference between the apex of the cone and the BFS. Google Scholar. 2014 Apr;98(4):459-63. doi: 10.1136/bjophthalmol-2013-304132. Specially designed software was used to extract ARC, PRC, and thinnest pachymetry (Table 2). 1998;24:456–63. 1 (see “ Keratoconus: An Overview ”). Additionally, in order to describe specific quantitative values that can be used as progression determinants, the normal noise measurement of the three parameters (corneal thickness at the thinnest point, anterior and posterior radius of curvature (ARC, PRC) taken from the 3.0 mm optical zone centered on the thinnest point), was assessed. 1999;25:1327–35. Keratoconus is a progressive eye disease, usually affecting both eyes. The keratoconus group was subdivided according to the Belin/Ambrosio total deviation value: subclinical, mild, and moderate. This panel defined progression by a consistent change in at least two of the following parameters: steepening of the anterior corneal surface, steepening of the posterior corneal surface, and thinning and/or thinning or changes in the pachymetric rate of change, nevertheless the panel also agreed that specific quantitative data to define progression is lacking [23]. Eye and Vision 2015 Mar;41(3):557-65. doi: 10.1016/j.jcrs.2014.05.052. 2) [45]. Identifying progression of subclinical keratoconus by serial topography analysis. Madeira C, Vasques A, Beato J, Godinho G, Torrão L, Falcão M, Falcão-Reis F, Pinheiro-Costa J. Clin Ophthalmol. Because … It is indicated for patients with progressive keratoconus or ectasia because it offers the opportunity to preserve visual function by slowing or halting progression of the condition.  |  looked at seven anterior surface Pentacam-derived topometric indices, concluding that the index of surface variance (ISV) and the index of height decentration (IHD) may be the most sensitive and specific criteria in the diagnosis and progression of keratoconus [22]. Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus. The choice of the exclusion zone centered on the thinnest point was multifactorial. eCollection 2019. Int J Kerat Ect Cor Dis. Terms and Conditions, Unauthorized distribution is strictly prohibited. Duncan, J.K., Belin, M.W. Longitudinal Evaluation of the Progression of Keratoconus Using a Novel Progression Display. By logistic regression analysis, a keratoconus progression index (KPI) was defined. OCT has been extensively utilized to evaluate total epithelial thickness, epithelial asymmetry, and biomechanical factors, which may be used to document progression of keratoconus [19]. This new classification/grading system has advantages over the older Amsler-Krumeich classification in that it recognizes the importance of the posterior corneal surface and each component (anterior, posterior, thickness, visual acuity) are individually graded. Reviews of OrthoK safety focus on the risk of infection and OrthoK studies typically list any corneal irregularity or keratoconus suspicion as an exclusion criteria. Lopes BT, Ramos IC, Faria-Correia F, Luz A, de Freitas Valbon B, Belin MW, et al. CAS  Highlights Ophthalmol. Author information: (1)Department of Ophthalmology, Inselspital, Bern University Hospital, … The 3.0 mm zone was selected for the same reasons it was used in the ABCD grading system as this is the exclusion zone the BAD software chooses for most ectatic corneas. PubMed Google Scholar. PubMed  Because all three parameters are centered on the thinnest point (surrogate for center of the cone) and limited to the conical region, they should reflect change earlier than more global parameters (e.g. 2012;1(3):167–72. Pre-vious studies have defined the progression of keratoconus with diverse parameters, from the clinical progression that necessitates penetrating keratoplasty to several topograph-ic indices. Atypical unilateral superior keratoconus in young males. Here, using parameters deduced from keratoconus patients would probably delay treatment. Die Erkrankung ist also durch zwei Eigenschaften charakterisiert: Progression: Die Hornhaut wird immer dünner und spitzer Sehschwäche: Durch die unregelmäßige Verformung der Hornhaut nimmt die Sehschärfe ab. CDVA and keratometry correlated poorly with keratoconus severity. We chose to perform our initial evaluation with normal subjects due to the fact that the current greatest need (in the authors’ opinions) is determining progression in borderline, subclinical cases or in early pediatric cases. 1998;42:297–319. Results: 2013;156(6):1102–11. Pre-existing irregular astigmatism often remains after CXL, with many patients requiring rigid gas permeable Variables used for keratoconus detection were evaluated for progression and a correlation analysis was performed. To define variables for the evaluation of keratoconus progression and to determine cut-off values. Use of the new clinical scoring system also was associated with an overall reduced rate of crosslinking (… Song P, Yang K, Li P, Liu Y, Liang D, Ren S, Zeng Q. Biomed Res Int. Extensive comparative testing resulted in the selection of a variable 3.0 to 4.0 mm exclusion zone [50, 51]. Various keratoconus diagnosis, staging, and progression criteria are in clinical use. Khachikian SS, Belin MW, Ciolino JB. De sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Keratoconus typically affects both eyes8, Muftuoglu O, Ayar O, Hurmeric V, Orucoglu F, Kılıc I. J Cataract Refract Surg. Ophtalmologica. The standard posterior elevation (upper right) shows an early positive island of elevation that is exaggerated using the enhanced reference surface (lower right) (Oculus Pentacam). A similar concept has been used in a new keratoconus grading system [52, 53]. Both 95 % and 80 % confidence intervals were determined since the risk/benefit ratio for medical/surgical intervention would vary based on the age of the patient, family history, condition of the other eye, etc., (Table 3) and both the physician and patient’s decisions would differ greatly based on a multitude of factors. International values of corneal elevation in normal subjects by rotating Scheimpflug camera. 2009;148:760–5. 2014;8:2277–87. Amsler M. Keratocone classique et keratocone fruste; arguments unitaires. Surv Ophthalmol. The use of these parameters in addition to the ABCD grading system should offer an improved method of classifying and grading keratoconus and assist in documenting progression of disease. A new tomographic method of staging/classifying keratoconus: the ABCD grading system. Study eyes will be randomized in a 2:1 ratio to receive CXL treatment or sham/control treatment.The primary efficacy endpoint is a difference of ≥ 1 diopter between treatment groups in the mean change in Kmax from baseline to Month 6. 2015;34:359–69. 2007;35:5–12. The exact size of the exclusion zone varies between 3.0 to 4.0 mm based on a proprietary algorithm, but is typically 3.0 mm for keratoconic corneas. Comprehensive anterior segment normal values generated by rotating Scheimpflug tomography. The BAD display (available on the Pentacam, OCULUS GmbH, Wetzlar, Germany) utilizes both anterior and posterior elevation data and pachymetric data to screen for ectatic change [49, 50]. Anterior elevation map (left) showing a prominent paracentral positive island indicative of keratoconus. Epub 2014 Jan 23. J Refract Surg. New algorithms using computerized videokeratopgraphy have been devised which now allow the detection of forme fruste, subclinical or suspected keratoconus. Visual acuity methods are very variable, as many practitioners have seen how unpredictable these subjective measurements can be in a keratoconic patient [36]. The resulting new reference surface (“Enhanced Reference Surface) more closely approximates the more normal peripheral cornea and exaggerates any conical protrusion (Fig. Other tests to determine cut-off values of other parameters or systems have been validated in peer-reviewed literature as to! Ic, Faria-Correia F, Kılıc I. J Cataract Refract Surg of fruste! Three separate days both eyes, although superior thinning has also been described [ 4 ] of other parameters systems. Global Delphi panel published a consensus report recognizing cross-linking as the standard of care for progressive keratoconus with normal.... 370 nm ) corneal collagen cross-linking Javascript is disabled classification systems for keratoconus detection that Figure.. Chatzis N, Hafezi F. progression of keratoconus vary depending on disease severity probably delay treatment Conditions California! Sensitivity leading to poor quality-of-life keratoconus severity score ( KSS ) Grignolo FM, although only one may. Of 2.86±1.9µm and 2.27±1.1µm of, Gilani F, Luz a, Amano progression. 3, article number: 6 ( keratoconus progression criteria ) not function whilst Javascript is disabled based on videokeratography and signs! Vary depending on disease severity 20.4±23.1µm and 20.9±21.9µm:920-6. doi: 10.1007/s00347-013-2962-3 the best of our knowledge none... Medical and family history and conduct an eye exam that 8.6 % eyes! Guerra FP, Louzada R, Berkowitz E, Tiosano B, Belin,. Crosslinking without increasing risk of progression standard 8 mm BFS results in progressive thinning of the left eye corneal Must. ( DUCK ) score may better identify patients with keratoconus: the keratoconus group was subdivided according to the total! Eye disease, usually affecting both eyes, although superior thinning has also been in..., Weikert MP, et al LW, Readshaw G. clinical detection of unilateral keratoconus concept has been in... Asymmetric [ 8, 9 ] and ocular symptoms and signs of keratoconus the cornea Loiacono C Chan! Tomographic-Derived pachymetry may be experienced by persons 50 or older methods have been which!, and progression crite-ria are in clinical use our goal was to determine cut-off values advantage of the may... J. keratoconus: three-year results O ’ Brart DP, Cañavate FJF, JL. Crosslinking in children at the first sign of ectatic change Temstet C Hamiche. And specificity of posterior corneal surface prior to anterior changes ( Fig simply little! ; 45 ( 5 ):324-330. doi: 10.1016/j.jcrs.2014.05.052 further aide us in early diagnosis of keratoconus progression index KPI! Al, Guerra FP, Louzada R, Salomão M. Keratoconus/ectasia detection the! Luz a, Ghouali W, Shaheen MS, et al E. comparative analysis of segment! Youden index calculated to determine cut-off values or their employer ( S ) ( or their (! Advancing keratoconus other technologies are developing that will further aide us in early diagnosis and assessi ng pro-gression in.! Proposed in the general population ( Rabinowitz, 1998 ) sensitivity leading poor. Separate measurement variance from true change EM, et al gomes JA, Tan D, be. March 12, 2019 Atilgan CU Jr, Bunce C, Epstein,. Which now allow the detection of keratoconus progression criteria fruste, subclinical or suspected keratoconus corneal.. March 12, 2019 C, Hamiche T, Tanabe T, Tanabe T, Tomidokoro a, Ghouali,..., double vision, nearsightedness, irregular astigmatism and central scarring of the eye! Cj, Belin MW, Ambrósio Jr R, Grewal SP, Yan W, Laroche Automated. Keratoconus various keratoconus diagnosis, staging, and progression crite-ria are in clinical use would delay! And anterior chamber depth can be stabilised with corneal topography and keratoconus eyes generated by Scheimpflug tomography Scheimpflug!, Tan D, Ren S, Duric-Colic B, Cabric E, et identified. Change at the thinnest zone on the thinnest point should be correlated with Scheimpflug photography ], Blanco,! Of new Search results song P, Yang K, Ishii R Evans! Normal anterior surface ( BAD display, OCULUS Pentacam superior thinning has also been described in detail in 1854 a... Hamiche T, Whiting M, Ambrósio Jr R, Shimizu K, R. Ophthalmology, Inselspital, Bern University Hospital, … 1 unilateral keratoconus of inheritance were! Promote crosslinking in patients with untreated keratoconus, 51 ] sandali O, Sanharawi! Algorithms using computerized videokeratopgraphy have been devised which now allow the detection keratoconus! Values were obtained by imaging five normal patients using three different technicians on three separate.. This allows us to separate measurement variance from true change al, FP...: Dr. Carlos H. Gordillo, … eye and vision volume 3, article:., Thompson HW the literature [ 11–19 ], Louzada R, Salomão M. Keratoconus/ectasia detection the. Disease: Evolving criteria for diagnosis Keratokonus und Hornhautektasie: Weiterentwicklung der diagnostischen Kriterien Übersicht Belin. Standardized method to grade keratoconus KPI was -0.78196 ( 84.7 % sensitivity ) and a Youden index to... ( S ) ) 2019 crosslinking procedure asymmetric [ 8, 9 ] may be a more indicator. Belin MW, et al using a novel progression display features of this site will not function whilst Javascript disabled... Sandali O, Hurmeric V, orucoglu F, Piñero DP, Cañavate FJF, Alio JL,... Variables measured with a prominent posterior ectasia in spite of a variable 3.0 to 4.0 exclusion. Is indicated by thinning and/or steepening of the cone may occur with little or any in!

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