Abstract
BackgroundReaching a consensus on which parameters are most reliable at detecting progressive keratoconus patients with serial topography imaging is not evident. The aim of the study was to isolate the parameters best positioned to detect keratoconus progression using the Pentacam HR® measures based on the respective limits of repeatability and range of measurement.MethodUsing the Pentacam HR®, a tolerance index was calculated on anterior segment parameters in healthy and keratoconic eyes. The tolerance index provides a scale from least to most affected parameters in terms of measurement noise relative to that observed in healthy eyes. Then, based on the “number of increments” from no disease to advanced disease, a relative utility (RU) score was also calculated. RU values close to 1 indicate parameters best positioned to detect a change in keratoconic eyes.ResultsThe tolerance index values indicated that 36% of ocular parameters for keratoconic eyes had repeatability limits which were wider than normative limits (worse), but 28% of the ocular parameters were narrower than normative limits (better). Considering only those parameters with a RU greater than 0.95, a small number of parameters were within this range, such as corneal curvature and asphericity indices.ConclusionsThis study demonstrates that measurement error in keratoconic eyes is significantly greater than healthy eyes. Indices implemented here provide guidance on the levels of expected precision in keratoconic eyes relative to healthy eyes to aid clinicians in distinguishing real change from noise. Importantly maximal keratometry (Kmax), central corneal thickness (CCT) and thinnest corneal thickness (TCT) were highlighted as problematic indices for the follow-up of keratoconus in terms of repeatability.
Highlights
Reaching a consensus on which parameters are most reliable at detecting progressive keratoconus patients with serial topography imaging is not evident
The tolerance index values indicated that 36% of ocular parameters for keratoconic eyes had repeatability limits which were wider than normative limits, but 28% of the ocular parameters were narrower than normative limits
This study demonstrates that measurement error in keratoconic eyes is significantly greater than healthy eyes
Summary
Reaching a consensus on which parameters are most reliable at detecting progressive keratoconus patients with serial topography imaging is not evident. The clinician who follows keratoconus patients with serial topography imaging desires to know which parameters are most reliable at detecting progression. This is important as the detection of progression will often determine treatment choice e.g., collagen cross-linking (CXL). Noting the important changes observed in repeatability limits with keratoconus, we aimed to determine which parameters were least affected. To isolate these parameters, we employed the tolerance and relative utility (RU) indices [17]. The tolerance index creates a scale of least to most affected parameters and the RU
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