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      Corneal topography in keratoconus: state of the art

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          Abstract

          The morphological characterization of the cornea using corneal topographers is a widespread clinical practice that is essential for the diagnosis of keratoconus. The current state of this non-invasive exploratory technique has evolved with the possibility of achieving a great number of measuring points of both anterior and posterior corneal surfaces, which is possible due to the development of new and advanced measurement devices. All these data are later used to extract a series of topographic valuation indices that permit to offer the most exact and reliable clinical diagnosis. This paper describes the technologies in which current corneal topographers are based on, being possible to define the main morphological characteristics that the keratoconus pathology produces on corneal surface. Finally, the main valuation indices, which are provided by the corneal topographers and used for the diagnosis of keratoconus, are also defined.

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          Global consensus on keratoconus and ectatic diseases.

          Jose A P Gomes, Donald Tan, Christopher J. Rapuano … (2015)
          Despite extensive knowledge regarding the diagnosis and management of keratoconus and ectatic corneal diseases, many controversies still exist. For that reason, there is a need for current guidelines for the diagnosis and management of these conditions. This project aimed to reach consensus of ophthalmology experts from around the world regarding keratoconus and ectatic diseases, focusing on their definition, concepts, clinical management, and surgical treatments. The Delphi method was followed with 3 questionnaire rounds and was complemented with a face-to-face meeting. Thirty-six panelists were involved and allocated to 1 of 3 panels: definition/diagnosis, nonsurgical management, or surgical treatment. The level of agreement considered for consensus was two thirds. Numerous agreements were generated in definitions, methods of diagnosing, and management of keratoconus and other ectatic diseases. Nonsurgical and surgical treatments for these conditions, including the use of corneal cross-linking and corneal transplantations, were presented in a stepwise approach. A flowchart describing a logical management sequence for keratoconus was created. This project resulted in definitions, statements, and recommendations for the diagnosis and management of keratoconus and other ectatic diseases. It also provides an insight into the current worldwide treatment of these conditions.
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            Baseline findings in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study.

            Julie Jameson, K Zadnik, David J. Sterling … (1998)
            To describe the baseline findings in patients enrolled in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. This is a longitudinal observational study of 1209 patients with keratoconus enrolled at 16 clinical centers. Its main outcome measures are corneal scarring, visual acuity, keratometry, and quality of life. The CLEK Study patients had a mean age of 39.29+/-10.90 years with moderate to severe disease, assessed by a keratometric-based criterion (95.4% of patients had steep keratometric readings of at least 45 D) and relatively good visual acuity (77.9% had best corrected visual acuity of at least 20/40 in both eyes). Sixty-five percent of the patients wore rigid gas-permeable contact lens, and most of those (73%) reported that their lenses were comfortable. Only 13.5% of patients reported a family history of keratoconus. None reported serious systemic diseases that had been previously reported to be associated with keratoconus. Many (53%) reported a history of atopy. Fifty-three percent had corneal scarring in one or both eyes. Baseline findings suggest that keratoconus is not associated with increased risk of connective tissue disease and that most patients in the CLEK Study sample represent mild to moderate keratoconus. Additional follow-up of at least 3 years will provide new information about the progression of keratoconus, identify factors associated with progression, and assess its impact on quality of life.
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              Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus.

              Abhijit Sinha Roy, Fernando Luz, F Guerra … (2011)
              To describe pachymetric progression indices (PPI) of the Pentacam HR (Oculus Optikgeräte GmbH) and the concept of relational thickness, and to test their accuracy for differentiating keratoconic and normal corneas compared with single-point thickness values. One hundred thirteen individual eyes randomly selected from 113 normal patients and 44 eyes of 44 patients with keratoconus were studied using the Pentacam HR by acquiring central corneal thickness (CCT), thinnest point (TP), position of the TP and PPI at minimal (PPI Min) and maximal (PPI Max) meridians, and the average (PPI Ave) of all meridians. Relational thickness parameters were calculated as the ratios of TP and CCT and PPI values. Mann-Whitney U test assessed differences in groups for each variable. Receiver operating characteristic (ROC) curves were calculated for all variables and pairwise comparisons were performed. Statistically significant differences were noted between normal and keratoconic eyes for all parameters (P<.001), except for horizontal position of TP (P=.79). The best parameters, named Ambrósio's Relational Thickness (ART), were ART-Ave (TP/PPI Ave) and ART-Max (TP/PPI Max) with areas under the ROC curves of 0.987 and 0.983, respectively. The best cutoffs were 424 μm and 339 μm for ART-Ave and ART-Max, respectively. Pachymetric progression indices and ART had a greater area under the curve than TP and CCT (P<.001); TP (0.955) had a greater area under the curve than CCT (0.909; P=.002). Tomographic-derived pachymetric parameters were better able to differentiate normal and keratoconic corneas than single-point pachymetric measurements. Further studies are needed to evaluate the role of tomography in identifying early forms of ectasia as well as ectasia risk among LASIK candidates. Copyright 2011, SLACK Incorporated.
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                Author and article information

                Contributors
                D. G. Fernández-Pacheco: daniel.garcia@upct.es
                Journal
                Journal ID (nlm-ta): Eye Vis (Lond)
                Journal ID (iso-abbrev): Eye Vis (Lond)
                Title: Eye and Vision
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2326-0254
                Publication date (Electronic): 22 February 2016
                Publication date PMC-release: 22 February 2016
                Publication date Collection: 2016
                Volume: 3
                Electronic Location Identifier: 5
                Affiliations
                [ ]Department of Graphical Expression, Technical University of Cartagena, C/Doctor Fleming s/n, Cartagena, 30202, Murcia Spain
                [ ]Faculty of Sports Science, C/ Santa Alicia s/n, Santiago de la Ribera, 30720 Murcia, Spain
                Article
                Publisher ID: 36
                DOI: 10.1186/s40662-016-0036-8
                PMC ID: 4762162
                PubMed ID: 26904709
                SO-VID: 479ef128-f43e-4b4c-9662-5a6da61fb082
                Copyright © © Cavas-Martínez et al. 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 15 September 2015
                Date accepted : 14 February 2016
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                Keywords: placido disc,detection system,topographer,diagnosis
                Data availability:
                Keywords: placido disc, detection system, topographer, diagnosis

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