J Kerat Ect Cor Dis. Weed KH, McGhee CN, Mac Ewen CJ. The ABCD Keratoconus Grading system currently available on the Topometric/Keratoconus Grading display on the OCULUS Pentacam. J Cataract Refract Surg. 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. Clin Ophthalmol. Each technician imaged each patient three times for each time period for a total of 27 images per patient, 135 images total. Open Access This 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. COVID-19 is an emerging, rapidly evolving situation. PubMed  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. To determine the measurement noise of the three parameters (corneal thickness at the thinnest point, and anterior and posterior radius of curvature (ARC, PRC) taken from the 3.0 mm optical zone centered on the thinnest point), five volunteer subjects were imaged, after obtaining informed consent, by three different technicians on three different days separated by 2 weeks (Pentacam HR, software version 6.08r13). PubMed  Up to 275 study eyes with progressive keratoconus will be enrolled. Epub 2015 Feb 21. Familial traits are also known. 1. Use of the new clinical scoring system also was associated with an overall reduced rate of crosslinking (… CAS  All authors read and approved the final manuscript. Needed in Keratoconus Diagnosis Criteria B ecause corneal collagen crosslinking (CXL) is intended to be applied to eyes developing progres-sive ectasia, it is of paramount importance to establish early and sensitive criteria to diagnose keratoconus and substantiate progression. Cont Lens Anterior Eye. Ophthalmology. A new tomographic method of staging/classifying keratoconus: the ABCD grading system. The use of normal subjects was based on practical reasons since it would be difficult to have patients return on multiple days for measurements, though this is something we will pursue in the future. Clin Ophthalmol. Aust N Z J Ophthalmol. California Privacy Statement, 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). In order to utilize these parameters as indicators of progression, the normal measurement noise needs to be known. Fam HB, Lim KL. Keratoconus (KC) is a disorder of the eye which results in progressive thinning of the cornea. This would be particularly true for decentered cones. Methods Eligibility Criteria for Considering Studies for Review Inclusion Criteria . 2015;69(2):91–4. Correspondence to 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]. Author information: (1)Department of Ophthalmology, Inselspital, Bern University Hospital, … Li X, Yang H, Rabinowitz YS. Ophthalmology. J Cataract Refract Surg. Values representing the progression of each analyzed 2. Ophthalmology. Several methods have been described in the literature to both evaluate and document progression in keratoconus, but there is no consistent or clear definition of ectasia progression. Longitudinal Evaluation of the Progression of Keratoconus Using a Novel Progression Display. Global consensus on keratoconus and ectatic disease. 2007;85(4):502–7. New algorithms using computerized videokeratopgraphy have been devised which now allow the detection of forme fruste, subclinical or suspected keratoconus. Agrawal, Swati DNB Ophth; Khurana, Ashi MS Ophth . With this information, both corneal thickness and anterior chamber depth can be computed. Similarly, the determination of progression, or the lack of, is paramount to determine when and if to treat and to document treatment efficacy. Belin MW, Duncan J. Keratoconus: The ABCD Grading System. Keratoconus and Ectatic… Klin Monatsbl Augenheilkd 2020; 237: 740–744 This document was downloaded for personal use only. Keratoconus usually becomes apparent during the second decade of the life, normally during puberty, and typically progresses until the fourth decade of life, when it usually stabilizes. Patients were removed from the instrument after each image. 1999;25:1327–35. A similar concept has been used in a new keratoconus grading system [52, 53]. Revisiting keratoconus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases Anastasios John Kanellopoulos,1,2 George Asimellis1 1Laservision.gr Eye Institute, Athens, Greece; 2New York University School of Medicine, New York, NY, USA Purpose: To survey the standard keratoconus … Evaluation of corneal elevation, pachymetry and keratometry in keratoconic eyes with respect to the stage of Amsler-Krumeich classification. 2009;148:760–5. Invest Ophthalmol Vis Sci. Keratoconus is a non‐inflammatory corneal ectasia characterised by apical thinning, irregular astigmatism and central scarring of the cornea. eCollection 2019. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values. MUCH ADO ABOUT KERATOCONUS TERMINOLOGY The currently used phrases « forme fruste », « early subclinical » or « keratoconus suspect » in keratoconus terminology is fraught with confusion. 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). 22 In a longitudinal study, Li et al identified videokeratographic indices predictive for the development of keratoconus in the normal eye of 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]. Today with the advent of treatments that can slow down if not halt the progression of keratoconus - it has become critically important to diagnose the disease as early as possible. It has been suggested that tomographic-derived pachymetry may be a more valuable method to document ectatic disease and follow progression [42]. The concept behind the “Enhanced Reference Surface” is to generate a reference surface that more closely resembles the patient’s own normal portion of the cornea as this will further magnify any existing pathology. Future work, however, will evaluate patients with mild to moderate disease. A number of other parameters or systems have been advocated to document progression [22, 25, 26, 34–40]. Comprehensive anterior segment normal values generated by rotating Scheimpflug tomography. Transepithelial accelerated versus conventional corneal collagen crosslinking in patients with keratoconus: a comparative study. Researchers in the Netherlands have revealed the Dutch Crosslinking for Keratoconus (DUCK) score may better identify patients with progressive keratoconus. Diagnosis can be made by slit-lamp examination and observation of central or inferior corneal thinning. Corneal thickness map (left) and Posterior elevation (right). Die Krankheit ist immer beidseitig, kann aber auf einem Auge schwächer ausgeprägt sein oder überhaupt nicht symptomatisch werden. Article  Sykakis E, Karim R, Evans JR, Bunce C, Amissah-Arthur KN, Patwary S, et al. 2014;3(1):1–8. volume 3, Article number: 6 (2016) J Kerat Ect Cor Dis. Fourier-domain optical coherence tomography imaging in keratoconus: a corneal structural classification. He is responsible for development of protocols on keratoconus monitoring and progression criteria and is actively involved in research into the effectiveness of both new and existing treatments for the condition. Various keratoconus diagnosis, staging, and progression criteria are in clinical use. Krumeich JH, Daniel J, Knülle A. Live-epikeratophakia for keratoconus. Mahmoud AM, Roberts CJ, Lembach RG, Twa MD, Herderick EE, McMahon TT. Keratoconus eyes showed anterior apex and maximum elevation changes of 20.4±23.1µm and 20.9±21.9µm. 6). 2012;28(11):753–8. Several classification systems for keratoconus have been proposed in the literature [11–19]. Mahmoud AM, Nuñez MX, Blanco C, Koch DD, Wang L, Weikert MP, et al. The 95 % and 80 % one-sided confidence intervals for all three parameters were surprisingly small (7.88/4.03 μm for corneal thickness, 0.024/0.012 mm for ARC, and 0.083/0.042 mm for PRC), suggesting that they may perform well as progression determinants. McMahon TT, Szczotka-Flynn L, Barr JT, Anderson RJ, Slaughter ME, Lass JH, et al. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus: three-year results. 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]. In the AK system, the severity of keratoconus is graded from stage 1–4 using spectacle refraction, central keratometry, presence or absence of scarring, and central corneal thickness [20]. Rabinowitz YS, Rasheed K. KISA % index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus. Assessment of Corneal Pachymetry Distribution and Morphologic Changes in Subclinical Keratoconus with Normal Biomechanics. 1) [33]. Extensive comparative testing resulted in the selection of a variable 3.0 to 4.0 mm exclusion zone [50, 51]. 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. Specifically, Oshika et al. 1 (see “ Keratoconus: An Overview ”). Kennedy RH, Bourne WM, Dyer JA. Others have used this system with various modification and additions in an attempt to better diagnosis or characterize the severity of disease [21, 22]. Ultrasound pachymetry can also be used to measure the thinnest zone on the cornea. 1991;112:41–5. J Cataract Refract Surg. One such program is the Belin-Ambrosio Enhanced Ectrasia Display (BAD). Rabinowitz YS, Nesburn AB, McDonnell PJ. Kmax, however, has been acknowledged as a poor parameter for both progression and crosslinking efficacy [31–35]. Google Scholar. Practical Observations on Conical Cornea: and on the Short Sight, and Other Defects of Vision Connected with it. 2019 Mar 1;13:445-452. doi: 10.2147/OPTH.S189183. Past treatments were for late disease and typically never returned the patient to normal visual function. Chastang PJ, Borderie VM, Carvajal-gonzalez S, Rostène W, Laroche L. Automated keratoconus detection using the EyeSys videokeratoscope. 1995;23:129–33. 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]. © 2021 BioMed Central Ltd unless otherwise stated. Please take a look at published article that evaluated key corneal parameters from Scheimpflug corneal tomography which were most reliable in … Keywords: keratoconus; progression; videokeratography 1. Anterior elevation map (left) showing a prominent paracentral positive island indicative of keratoconus. 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. 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. Belin MW, Duncan JK. Here, the normal patient variation is probably more applicable and more closely approximates very early disease than values determined from known cases of keratoconus. In this retrospective cohort study (2010-2016), 265 eyes of 165 patients diagnosed with keratoconus underwent two Scheimpflug measurements (Pentacam) that took place 1 year apart ±3 months. 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