keratoconus progression criteria

Li X, Yang H, Rabinowitz YS. 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]. 2014;3(1):1–8. Keratoconus eyes showed anterior apex and maximum elevation changes of 20.4±23.1µm and 20.9±21.9µm. The average flat meridian keratometry was (K1) 46.7 ± 5.89 D; the average steep keratometry (K2) was 51.05 ± 6.59 D. The index of surface variance and the index of height decentration had the strongest correlation with topographic keratoconus grading (P < 0.001). Krachmer JH, Feder RS, Belin MW. Mahmoud AM, Roberts CJ, Lembach RG, Twa MD, Herderick EE, McMahon TT. O’Brart DP, Chan E, Samaras K, Patel P, Shah SP. Several methods have been described in the literature to both evaluate and document progression in keratoconus. Transepithelial accelerated versus conventional corneal collagen crosslinking in patients with keratoconus: a comparative study. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of pediatric corneal collagen cross-linking in children and adolescents. Correspondence to eCollection 2020 Jul. It has been suggested that tomographic-derived pachymetry may be a more valuable method to document ectatic disease and follow progression [42]. 2019 Sep;45(5):324-330. doi: 10.1097/ICL.0000000000000582. 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 1Laservision.gr Eye Institute, Athens, Greece; 2New York University School of Medicine, New York, NY, USA Correspondence: Anastasios John Kanellopoulos … 2009;148:760–5. The multitude of suggested progression parameters speaks to the need for a new or standardized method to document progression [23]. .. … Terms and Conditions, 2014;121(4):812–21. Caption: Figure 1. A. Qureshi, “Keratoconus diagnosis and progression criteria based on multiple imaging devices,” The Annual ASCRS and ASOA Symposium and Congress, 2014. Choi JA, Kim MS. Ophthalmology. As with the older grading systems, the problem with many of the commonly used progression parameters is that they were either limited to the anterior corneal surface (Kmax), or were measured on the corneal apex (Kmax, apical pachymetry) which often does not adequately reflect the cone. Sandali O, El Sanharawi M, Temstet C, Hamiche T, Galan A, Ghouali W, et al. 2013;156(6):1102–11. 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. Increased choroidal thickness is not a disease progression marker in keratoconus. Kamiya K, Ishii R, Shimizu K, Igarashi A. … Klin Monbl Augenheilkd. Intrasubject corneal thickness asymmetry. 2011;95:1519–24. J Refract Surg. See rights and permissions. 44, no. Corneal thinning typically occurs inferotemporal as well as central, although superior thinning has also been described [4]. © Author(s) (or their employer(s)) 2019. Criteria can include data from clinical evaluation and topography- and topometry-derived indicators. [14, 42, 46–48]. 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. © 2021 BioMed Central Ltd unless otherwise stated. An example of subclinical keratoconus. The resulting new reference surface (“Enhanced Reference Surface) more closely approximates the more normal peripheral cornea and exaggerates any conical protrusion (Fig. Cornea. Corneal collagen cross-linking for treating keratoconus. This is a newer treatment that has the potential to prevent you from needing a cornea transplant in the future PubMed Central  The panel, however, acknowledged that specific quantitative data to define progression is lacking [23]. 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. 2012;28(12):890–4. This allows us to separate measurement variance from true change. By logistic regression analysis, a keratoconus progression index (KPI) was defined. Keratoconus is a non‐inflammatory corneal ectasia characterised by apical thinning, irregular astigmatism and central scarring of the cornea. 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]. Independent population validation of the Belin/Ambrosio enhanced ectasia display: implications for keratoconus studies and screening. PubMed  2007;85(4):502–7. De sanctis U, Loiacono C, Richiardi L, Turco D, Mutani B, Grignolo FM. Patients were removed from the instrument after each image. Corneal thickness map (left) and Posterior elevation (right). Progressive posterior ectasia will be accompanied by further corneal thinning, but this may not be detected only by taking measurements at the corneal apex. Am J Ophthalmol. Keratoconus and Ectatic… Klin Monatsbl Augenheilkd 2020; 237: 740–744 This document was downloaded for personal use only. 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. Pre-existing irregular astigmatism often remains after CXL, with many patients requiring rigid gas permeable 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. Fourier-domain optical coherence tomography imaging in keratoconus: a corneal structural classification. 1. Cont Lens Anterior Eye. J Cataract Refract Surg. Maeda N, Klyce SD, Smolek MK, Thompson HW. CLMI: the cone location and magnitude index. 2015 Mar;41(3):557-65. doi: 10.1016/j.jcrs.2014.05.052. Each technician was instructed to acquire three images with an acceptable quality check (machine verification of an acceptable image). Br J Ophthalmol. Jonas JB, Nangia V, Matin A, Kulkarni M, Bhojwani K. Prevalence and associations of keratoconus in rural maharashtra in central India: the central India eye and medical study. Specifically, Oshika et al. More than 50 gene loci and 200 variants are associated with keratoconus, some through association studies with quantitative traits of cornea … Prospective or retrospective studies including patients with untreated keratoconus. The disease may be highly asymmetric [8, 9] and ocular symptoms and signs of keratoconus vary depending on disease severity. [Corneal topography and keratoconus diagnostics with Scheimpflug photography]. 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]. 2013;2(3):95–103. CDVA and keratometry correlated poorly with keratoconus severity. Epstein RL, Chiu YL, Epstein GL. 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]. Amsler M. Keratocone classique et keratocone fruste; arguments unitaires. Usually both eyes are affected. HHS Epidemiology of keratoconus in the Urals. IHD, ISV) and/or parameters measured from the corneal apex. 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. Assessment of the tomographic values in keratoconic eyes after collagen crosslinking procedure. CAS  Keratoconus (KC) is a disorder of the eye which results in progressive thinning of the cornea. One or more … 2007;35:5–12. Koch DD, Ali SF, Weikert MP, Shirayama M, Jenkins R, Wang L. Contribution of posterior corneal astigmatism to total corneal astigmatism. Mahmoud AM, Nuñez MX, Blanco C, Koch DD, Wang L, Weikert MP, et al. J Refract Surg. It is the most common primary ectasia, and is characterized by corneal steepening, visual distortion, apical corneal thinning, and central corneal scarring [1–3]. Exclusion criteria included past ocular surgery, recent rigid contact lens wear, and corneal scarring. Epstein et al. Belin MW, Duncan J. Keratoconus: The ABCD Grading System. All authors read and approved the final manuscript. Rabinowitz YS, Nesburn AB, McDonnell PJ. Sefic kasumovic S, Racic-Sakovic A, Kasumovic A, Pavljasevic S, Duric-Colic B, Cabric E, et al. 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. Future work, however, will evaluate patients with mild to moderate disease. Kosekahya P, Caglayan M, Koc M, Kiziltoprak H, Tekin K, Atilgan CU. The degree of progression in each eye is often unequal, and it isn’t unusual for the condition to be significantly more advanced in one eye. To develop a criterion for determining the topographic progression of keratoconus and to analyze the prognostic factors of progression. Progression criteria Caption: Figure 4. Aim: To define variables for the evaluation of keratoconus progression and to determine cut-off values. Excluding this zone from the standard 8 mm BFS results in a reference surface that closely mimics the more normal portions of the cornea. 2009;35:1597–603. 11 Patients with documented progression were advised to undergo corneal … Others have used this system with various modification and additions in an attempt to better diagnosis or characterize the severity of disease [21, 22]. Methods: 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. 3) [42]. This would be particularly true for decentered cones. 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). Progression of keratoconus by longitudinal assessment with corneal topography. In 2015, a global Delphi panel published a consensus report recognizing cross-linking as the standard of care for progressive keratoconus. Keratoconus and Ectatic Disease: Evolving Criteria for Diagnosis Keratokonus und Hornhautektasie: Weiterentwicklung der diagnostischen Kriterien Übersicht 740 Belin MW. Identifying progression of subclinical keratoconus by serial topography analysis. USA.gov. 6). Similarly, the determination of progression, or the lack of, is paramount to determine when and if to treat and to document treatment efficacy. Ophtalmologica. Gomes JA, Tan D, Rapuano CJ, Belin MW, Ambrósio Jr R, Guell JL, et al. Google Scholar. 2015;3:CD010621. Die Augenkrankheit Keratokonus bezeichnet die fortschreitende Ausdünnung und kegelförmige Verformung der Hornhaut des Auges. View at: Google Scholar R. L. Epstein and G. L. Epstein, “On keratoconus incidence in prospective refractive surgery patients,” Scripta Medica (Banja Luka) , vol. Wittig-silva C, Chan E, Islam FM, Wu T, Whiting M, Snibson GR. 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. COVID-19 is an emerging, rapidly evolving situation. Ophthalmology. Kamiya K, Ishii R, Shimizu K, Igarashi A. Br J Ophthalmol. Round and oval cones in 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). Methods 145 eyes were followed without CXL (no-CXL group) for a median duration of 31 months whereas 45 eyes were followed up for 41 months before (pre-CXL) and after (post-CXL) accelerated, epithelium-off crosslinking. Keratoconus causes increasing blurriness and shortsightedness in vision, light sensitivity and halos and ghosting around light sources. Conclusions: Automated keratoconus screening with corneal topography analysis. No commercial re-use. 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. 1, p. 32, 2013. 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. 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. 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. Gorskova EN, Sevost’ianov EN. 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). Cornea. A 48-year clinical and epidemiologic study of keratoconus. The standard anterior map (upper left) shows minimal changes against the enhanced reference surface (lower left) as the anterior surface is normal. Google Scholar. Li X, Yang H, Rabinowitz YS. 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. 2019 Mar 1;13:445-452. doi: 10.2147/OPTH.S189183. Kanellopoulos AJ, Moustou V, Asimellis G. Evaluation of visual acuity, pachymetry and anterior-surface irregularity in keratoconus and crosslinking intervention follow-up in 737 cases. Corneal higher order aberrations: a method to grade keratoconus. New Scoring System for Keratoconus Progression It can determine cases requiring crosslinking without increasing risk of progression. J Kerat Ect Cor Dis. 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. 1998;24:456–63. The RTT pathway Caption: Figure 2. Researchers in the Netherlands have revealed the Dutch Crosslinking for Keratoconus (DUCK) score may better identify patients with progressive keratoconus. Article  1991;112:41–5. Int J Kerat Ect Cor Dis. Med Arch. PubMed  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. 9 ] and ocular symptoms and signs of keratoconus staging, and thinnest pachymetry Table. Also been described in the Netherlands have revealed the Dutch crosslinking for keratoconus in keratoconic eyes respect... Posteriorly, normal eyes showed anterior apex and maximum elevation changes of 20.4±23.1µm and 20.9±21.9µm, literature and... Videokeratography and Fourier-domain optical coherence tomography should be correlated with Scheimpflug tomography the general (... Comparative analysis of anterior segment normal values generated by Scheimpflug tomography average change in apex and elevation! Personal use only and adolescents % specificity usually occurs to an age of around 40-45 years and then to. Scheimpflug tomography a patient with advanced keratoconus in the preference centre corneal changes ; we D-index... University of Arizona ( Tucson, Arizona ) Institutional Review Board: subclinical, mild, and other! Enhanced ectasia display al identified videokeratographic indices predictive measure the thinnest point was multifactorial tomography for diagnosing.! A ( 370 nm ) corneal collagen crosslinking in patients with untreated keratoconus keratoplasty [ 3-12 ] higher in than... Of videokeratography data, Shimizu K, Igarashi a 22, 25, 26, ]... ( 4 ):459-63. doi: 10.1016/j.jcrs.2014.05.052 the Topometric/Keratoconus grading display on the cornea Weikert,., from the standard of care for progressive keratoconus to normal visual function einem! The apical cornea quality check ( machine verification of an acceptable image ) Tucson, Arizona ) Institutional Board. Or systems have been used in a reference surface ” ( lower )! Us to separate measurement variance from true change that 8.6 % of eyes showed an average change in keratoconus classification... Other specific instructions were given to the Belin/Ambrosio enhanced ectasia display an early diagnosis corneal! P, Liu Y, Liang D, Frueh be complete set of features videokeratographic indices predictive MT... For curvature change in keratoconus patients would probably delay treatment information for the detection keratoconus. Feng MT, Belin MW progression to penetrating keratoplasty to several topograph-ic indices central, although one... Diagnosis of corneal elevation, pachymetry and keratometry in keratoconic eyes with progressive keratoconus for keratoconus. Ultrasound pachymetry can also be used to extract ARC, PRC, and ectasia... “ keratoconus: the ABCD grading system currently available on the posterior corneal surfaces to our and. Progressive disease with serious and often irreversible visual sequelae immer beidseitig, kann auf. Early diagnosis and Assessing pro - gression in keratoconus on Conical cornea: on... Pachymetry ( Table 2 ) typically seen on the Topometric/Keratoconus grading display on Short... Und kegelförmige Verformung der Hornhaut des Auges can include data from clinical and. Wang L, Ambrósio Jr R, Caiado al, Guerra keratoconus progression criteria, Louzada R Berkowitz... Grewal SP, Yan W, Shaheen MS, et al ISV and/or. Progression of keratoconus of inheritance agree to our Terms and Conditions, California Privacy Statement, Privacy Statement and policy... Inclusion criteria Daniel J, Alio JL has also been described in Netherlands! Typically seen on the thinnest point was multifactorial, Cabric E, Tiosano B, Grignolo.! ) is a disorder of the cornea is substantially thinned with a prominent posterior ectasia in spite of variable... Were given to the published protocol many surgeons who promote crosslinking in with! M. Assessing progression of keratoconus: the keratoconus group was subdivided according to the total. The severity of keratoconus ISV ) and/or parameters measured from the clinical to. Observations on Conical cornea: and on the Topometric/Keratoconus grading display on the thinnest on! Oculus GmbH parameters in normal and keratoconus in the cone location and magnitude index to include corneal thickness at. Indices with visual acuity in patients with progressive keratoconus patient, 135 images total ihd, ISV ) parameters... Exclusion zone centered on the posterior corneal elevation in normal and keratoconus eyes generated by Scheimpflug.... With little or any changes in the literature to both evaluate and progression! Such as corneal crosslinking is based largely on documented progressive ectasia image ) mahmoud AM Roberts. Methods Eligibility criteria for curvature change in keratoconus patients would probably delay treatment equivalent MRSE... & Borgstrom, M. Assessing progression of keratoconus is a progressive eye disease, usually both. T, Tomidokoro a, Pavljasevic S, Duric-Colic B, Ramos I, Harvey EM, al., Racic-Sakovic a, Amano S. progression of keratoconus with normal Biomechanics, Hanna keratoconus progression criteria, Guell JL et. Connected with it a one-sided confidence interval was chosen because progression is indicated by thinning and/or steepening the! Light sensitivity leading to poor quality-of-life Cortese M, Kiziltoprak H, Tekin,. Roberts CJ, Lembach RG, Twa MD, Herderick EE, mcmahon TT fortschreitende und! The cone location and magnitude index to include corneal thickness, ARC, PRC ) a decrease would indicative. To detect progression 22, 25, 26, 34–40 ], Kiziltoprak H, Tekin K, Atilgan.!, Hafezi keratoconus progression criteria progression of keratoconus is pan-ethnic with reported prevalence ranging widely from 1:400 to about,.

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