Abstract
Numerous approaches have been designated to document progression in keratoconus, nevertheless there is no consistent or clear definition of ectasia progression. In this present study, we aim to evaluate Keratoconus Enlargement (KCE) as a parameter to document ectasia progression. We define KCE as an increase of more than 1D in the anterior curvature of non-apical corneal areas. We have designed a longitudinal study in 113 keratoconic eyes to assess keratoconus progression. KCE was compared with variables commonly used for detection of keratoconus progression like Kmax, Km, K2, PachyMin, D-Index, Corneal Astigmatism and PRC of 3.0 mm centered on the thinnest point. The variations of keratometric readings, D-index and ELEBmax showed positive associations with KCE. Evaluating the performance of Kmax, D-index and KCE as isolated parameters to document keratoconus progression we found a sensitivity of 49%, 82% and 77% and a specificity of 100%, 95% and 66% to detect keratoconus progression (p < 0.001 for all). This difference in sensitivity can be explained by the changes in keratoconus outside the small area represented by Kmax. The inclusion of KCE should be considered in the evaluation of keratoconus progression in conjunction with other variables to increase the reliability of our clinical evaluation.
Highlights
Numerous approaches have been designated to document progression in keratoconus, there is no consistent or clear definition of ectasia progression
We wanted to evaluate the performance of Keratoconus Enlargement (KCE) to document keratoconus progression
The authors defined KCE as an increase of more than 1D in the anterior curvature of non-apical corneal areas, out of the small area represented by Kmax
Summary
Numerous approaches have been designated to document progression in keratoconus, there is no consistent or clear definition of ectasia progression. Evaluating the performance of Kmax, D-index and KCE as isolated parameters to document keratoconus progression we found a sensitivity of 49%, 82% and 77% and a specificity of 100%, 95% and 66% to detect keratoconus progression (p < 0.001 for all). This difference in sensitivity can be explained by the changes in keratoconus outside the small area represented by Kmax. It is very important to know what patients will progress to apply cross-linking early and to prevent more severe stages of the d isease[17] For those reasons, finding a standardized method to document progression is essential and nowadays there is still no clear definition for this. Efforts have been done to find the most reliable variables to explain
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