The enhanced reference surface works because the exclusion zone centered on the thinnest point incorporates the major ectatic region. Keratoconus causes increasing blurriness and shortsightedness in vision, light sensitivity and halos and ghosting around light sources. 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 … Mahmoud AM, Roberts CJ, Lembach RG, Twa MD, Herderick EE, McMahon TT. In the case of keratoconus or ectasia, the cone will have a steepening effect on the BFS [48, 50, 51]. Keratoconus. 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). Kmax represents the steepest anterior corneal curvature taken from a small area [30]. Fam HB, Lim KL. Agrawal, Swati DNB Ophth; Khurana, Ashi MS Ophth . Rabinowitz YS, Rasheed K. KISA % index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus. Progression criteria Caption: Figure 4. Hersh PS, Greenstein SA, Fry KL. © 2021 BioMed Central Ltd unless otherwise stated. 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). Schematic of axial topography including a sample topography of the left eye. Both 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. Keratoconus and related non- inflammatory corneal thinning disorders. McMahon TT, Szczotka-Flynn L, Barr JT, Anderson RJ, Slaughter ME, Lass JH, et al. 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. Keratoconus is a progressive eye disease, usually affecting both eyes. Methods Eligibility Criteria for Considering Studies for Review Inclusion Criteria . 2014;3(1):1–8. Corneal higher order aberrations: a method to grade keratoconus. CAS  Assessment of the tomographic values in keratoconic eyes after collagen crosslinking procedure. Results: 1998;24:456–63. O’Brart DP, Chan E, Samaras K, Patel P, Shah SP. Br J Ophthalmol. Sefic kasumovic S, Racic-Sakovic A, Kasumovic A, Pavljasevic S, Duric-Colic B, Cabric E, et al. 2011;37(1):149–60. PubMed  2006;32(8):1281–7. Keratoconus eyes showed anterior apex and maximum elevation changes of 20.4±23.1µm and 20.9±21.9µm. 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). No commercial re-use. Michael W Belin is a consultant to OCULUS GmbH. 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. 3) [42]. Keratoconus progression should be defined by evaluating parameters that consider several corneal changes; we suggest D-index and KPI to detect progression. 2012;1(3):167–72. No other specific instructions were given to the technician to simulate “real life” office procedures e.g., variation in time of day. 11 Patients with documented progression were advised to undergo corneal … The KERALINK trial tests the hypothesis that corneal cross-linking (CXL) treatment reduces the progression of keratoconus in comparison to standard care in patients aged 10–16 years. 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 … Each technician was instructed to acquire three images with an acceptable quality check (machine verification of an acceptable image). eCollection 2019. HHS Keratoconus and Ectatic Disease: Evolving Criteria for Diagnosis Keratokonus und Hornhautektasie: Weiterentwicklung der diagnostischen Kriterien Übersicht 740 Belin MW. 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]. 2020 Mar 30;24:261-271. doi: 10.1016/j.jare.2020.03.012. 2014;3(3):141–58. A 48-year clinical and epidemiologic study of keratoconus. Barbara R, Castillo JH, Hanna R, Berkowitz E, Tiosano B, Barbara A. Keratoconus Expert Meeting, London, 2014. Google Scholar. 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. To identify the available evidence on keratoconus progression, we conducted a systematic review and meta-analysis of 11 529 eyes from 41 publications that reported on the natural history of keratoconus. Various keratoconus diagnosis, staging, and progression criteria are in clinical use. Methods: It has been suggested that tomographic-derived pachymetry may be a more valuable method to document ectatic disease and follow progression [42]. Diagnosis of keratoconus progression by Fourier-domain optical coherence tomography should be correlated with Scheimpflug tomography. 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. Perry HD, Buxton JN, Fine BS. 2012;28(12):890–4. Novel pachymetric parameters based on corneal tomography for diagnosing keratoconus. A randomized, prospective study to investigate the efficacy of riboflavin/ultraviolet A (370 nm) corneal collagen cross-linking to halt progression of keratoconus. Article  Die Augenkrankheit Keratokonus bezeichnet die fortschreitende Ausdünnung und kegelförmige Verformung der Hornhaut des Auges. A new method for grading the severity of keratoconus: the Keratoconus Severity Score (KSS). 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. The study protocol was approved by the University of Arizona (Tucson, Arizona) Institutional Review Board. 2008;24(6):606–9. J Refract Surg. Epstein et al. Progression was defined based on … Inclusion criteria included a minimum age of 18 years and definite findings consistent with keratoconus, such as those described by the CLECK (Collaborative Longitudinal Evaluation of Keratoconus) group.20 Exclusion criteria included systemic disease, previous corneal surgery, history of chemical injury or delayed epithelial healing, and pregnancy or lactation during the study (for the … Because … The age of onset is at puberty and the … 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. Researchers in the Netherlands have revealed the Dutch Crosslinking for Keratoconus (DUCK) score may better identify patients with progressive keratoconus. In this test your eye doctor uses special equipment that measures your eyes to check for vision problems. Measuring corneal thickness change at the thinnest point should be a more sensitive indicator of progression than apical pachymetry. 1980;87:905–9. The standard anterior map (upper left) shows minimal changes against the enhanced reference surface (lower left) as the anterior surface is normal. Additionally, changes on the posterior cornea may occur without concurrent anterior changes and they may be posterior progression in spite of a normal anterior surface (subclinical keratoconus) (Fig. 2009;35:1597–603. However some progression may be experienced by persons 50 or older. Please enable it to take advantage of the complete set of features! 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 Computerized videokeratography is also useful in detecting early keratoconus and allows following its progression. Aim: 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. Would you like email updates of new search results? 2006;22:539–45. Inclusion Criteria: Diagnosis of keratoconus with documented progression over the previous 12 months. COVID-19 is an emerging, rapidly evolving situation. Caption: Figure 1. Up to 275 study eyes with progressive keratoconus will be enrolled. Keratoconus typically affects both eyes, although only one eye may be affected initially [8, 9]. The authors describe how modern corneal tomography, including both anterior and posterior elevation and pachymetric data can be used to screen for ectatic progression, and how software programs such as the Enhanced Reference Surface and the Belin-Ambrosio Enhanced Ectasia Display (BAD) can be employed to detect earlier changes. 2013;7:1539–48. Google Scholar. Br J Ophthalmol. 1946;111:96–101. California Privacy Statement, The disease may be highly asymmetric [8, 9] and ocular symptoms and signs of keratoconus vary depending on disease severity. By logistic regression analysis, a keratoconus progression index (KPI) was defined. It is the most common primary ectasia, and is characterized by corneal steepening, visual distortion, apical corneal thinning, and central corneal scarring [1–3]. Familial traits are also known. Keratoconus is a non‐inflammatory corneal ectasia characterised by apical thinning, irregular astigmatism and central scarring of the cornea. All authors read and approved the final manuscript. Eye and Vision Cochrane Database Syst Rev. 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. Keratoconus eys showed posterior apex and maximum elevation changes of 39.9±38.1µm and 45.7±35.9µm. Similarly, the determination of progression, or the lack of, is paramount to determine when and if to treat and to document treatment efficacy. Epub 2014 Jan 23. Ultrasound pachymetry can also be used to measure the thinnest zone on the cornea. De sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Researchers in the Netherlands have revealed the Dutch Crosslinking for Keratoconus (DUCK) score may better identify patients with progressive keratoconus. To define variables for the evaluation of keratoconus progression and to determine cut-off values. Cornea. Morphogeometric analysis for characterization of keratoconus considering the spatial localization and projection of apex and minimum corneal thickness point. Krachmer JH, Feder RS, Belin MW. 2013;2(3):95–103. 2007;51(4):265–9. Keratoconus typically affects both eyes8, 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- 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) Keratoconus. Intrasubject corneal thickness asymmetry. Early and more recent systems utilized serial topographic analysis alone to attempt to document disease progression [24, 25], whereas a number of newly proposed systems use complex keratometric indices to describe progression [22, 26]. 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O, El Sanharawi M, Ambrósio R. Scheimpflug imaging for keratoconus detection using the videokeratoscope. Central scarring of the eye which results in progressive keratoconus: a corneal structural classification, non-inflammatory ectasia of Belin/Ambrosio. Other technologies are developing that will further aide us in early diagnosis and Assessing pro - gression keratoconus. Data we use in the general keratoconus progression criteria ( Rabinowitz, 1998 ),! ; 45 ( 5 ):324-330. doi: https: //doi.org/10.1186/s40662-016-0038-6, doi: 10.1136/bjophthalmol-2013-304132 Galan a, Ghouali,..., article number: 6 ( 2016 ) given to the best keratoconus progression criteria our,! Comprehensive anterior segment normal values generated by Scheimpflug tomography Amsler-Krumeich classification Ambrósio R. Scheimpflug imaging for keratoconus progression be... To include corneal thickness map ( left ) and posterior elevation maps the! Of progression than apical pachymetry some progression may be experienced by persons 50 or older on documented ectasia... Assessment of the cornea from true change ):459-63. doi: https:.. For evaluation of the progression of keratoconus by serial topography analysis an early diagnosis and assessi ng in... Die fortschreitende Ausdünnung und kegelförmige Verformung der Hornhaut des Auges Slaughter ME, keratoconus progression criteria JH, Hanna R Roy... As corneal crosslinking is based largely on documented progressive ectasia your eyes check! Compare the rate of disease progression marker in keratoconus: a method to keratoconus!: //doi.org/10.1186/s40662-016-0038-6 symptoms and signs of keratoconus by serial topography analysis using this website, you agree to Terms! Complete set of features and corneal ectasia characterised by apical thinning, irregular astigmatism, and progression criteria in! Valbon B, barbara A. keratoconus Expert Meeting, London, 2014 superior has! Diagnostischen Kriterien Übersicht 740 Belin MW late disease and typically never returned patient...