Prevalence of Abnormal Ectasia Screening Indices and the Predictive Value of Anterior Keratometry in Refractive Surgery Candidates.

Tomographic and densitometric corneal alterations in asymptomatic offspring of patients with keratoconus: a Turkish cross-sectional study

Interobserver Variability in the Identification of Keratoconus Suspects Among Teenagers and Young Adults: Comparison With Scheimpflug Tomographic Indices.

PURPOSE To evaluate interobserver agreement between 2 experienced corneal specialists in classifying eyes as normal (N), keratoconus-suspect (KCN-S), or keratoconic (KCN) using Scheimpflug tomography, and to assess the discriminatory performance of tomographic asymmetry indices. METHODS A total of 206 eyes from 103 participants (15-25 years) underwent Scheimpflug corneal tomography. Two experienced corneal specialists independently classified each eye based solely on four-map displays, without access to quantitative tomographic indices (BAD-D, ISV, IHD, IVA). Interobserver agreement was assessed using Cohen κ statistic. Discriminatory performance was evaluated by receiver operating characteristic (ROC) analysis and area under the curve (AUC), with observer classifications retrospectively compared with BAD-D, ISV, IHD, and IVA. RESULTS Interobserver agreement was moderate (κ = 0.40, P <0.01). Agreement between observer classifications and BAD-D was substantial for observer 1 (κ = 0.70, P <0.01) and fair for observer 2 (κ = 0.35, P <0.01). Among the evaluated indices, BAD-D demonstrated the highest discriminatory performance (AUC = 0.94 and 0.85 using observer 1 and observer 2 classifications, respectively). In expert consensus cases, BAD-D achieved an AUC of 0.97. A BAD-D threshold of 1.10 yielded 90% sensitivity and 90% specificity. CONCLUSIONS Moderate interobserver agreement highlights the diagnostic uncertainty of identifying early keratoconus-suspect eyes and may contribute to variability in reported keratoconus prevalence. Among the evaluated tomographic indices, BAD-D showed the strongest agreement with expert classifications and the greatest discriminatory ability, supporting its use as an adjunctive tool for early screening in young individuals.

Combined Scheimpflug-Derived Tomographic and Biomechanical Assessment Detection: A Systematic Review

Purpose: Keratoconus is the most common corneal ectatic disease, characterized by progressive and bilateral thinning of the cornea leading to visual loss. Early diagnosis is important, particularly in preoperative screening, and the utilization of another imaging modality remains crucial. This study aimed to explore the combination of corneal biomechanical tomographic assessment derived from Scheimpflug in diagnosing subclinical keratoconus. Methods: A systematic search was conducted in MEDLINE, Google Scholar, Clinical Key, and EBSCO. Two independent reviewers selected studies and extracted data. Risk of bias was assessed using the QUADAS-2 tool in RevMan 5.4. The primary outcome measures included the Belin-Ambrosio enhanced ectasia total deviation index (BAD-D), Stiffness Parameter at First Applanation (SPA-1), Tomographic & Biomechanical Index (TBI), and Corvis Biomechanical Index (CBI). Diagnostic accuracy was categorized based on the area under the curve (AUC) as low (AUC < 0.7), moderate (0.7 ≤ AUC < 0.9), or high (AUC ≥ 0.9). Results: Twelve studies involving 3483 eyes were included BAD-D and CBI demonstrated low to moderate AUC, while TBI demonstrated moderate to high AUC. According to the QUADAS-2, common methodological limitations included inappropriate reference standards, unclear patient selection, and inconsistent exclusion criteria. Limitations include numerous issues with methodological and findings reporting, thus a meta-analysis was not conducted. Conclusion: Scheimpflug-based corneal tomographic and biomechanical assessment shows promise as an adjunctive tool for detecting subclinical keratoconus. Among the indices, TBI appears to provide the highest diagnostic performance. However, further high-quality, longitudinal studies are required to validate these findings and to develop standardized diagnostic criteria.

Clinical Profile, Risk factors and Topographic Characteristics of Keratoconus at a Tertiary Eye Hospital: An Observational Study

Introduction: Keratoconus is a non-inflammatory, progressive thinning, most commonly bilateral condition of the cornea involving the central two-thirds of the cornea. The study aimed to assess the clinical profile, risk factors, and topographic parameters. Methods: An observational study was conducted from March to November 2024 among patients with clinically and topographically diagnosed keratoconus. Corneal topography-800 and the Amsler–Krumeich classification were used for diagnosis and grading. Binary variables were summarized as frequencies and percentages, while continuous variables were expressed as mean, standard deviation, and coefficient of variation. Results: Among the 82 keratoconus patients 120 eyes were evaluated, the mean age of presentation was 22.37±8.7 years. The study population included 64 (78.05%) males and 18 females (21.95%). Reported risk factor were eye rubbing 52 (37.96%), ocular allergy 44 (32.12%). Unilateral keratoconus was seen in 46 (56.10%) cases. The observed clinical sign was scissor reflex 62 (75.61%), stromal thinning 50 (60.98%) and Vogt's striae 36 (43.90%). Refractive parameters showed considerable variation, with spherical power averaging -1.16±2.05 D and cylindrical power at -4.16±2.88 D, confirming significant myopia and astigmatism. Corneal curvature was increased, with a mean K value of 47.30±5.50 D, and the surface asymmetry index was 2.44±2.19, indicating variations in corneal topography. Conclusions: In this study, majority of the patients were in early twenty's age group. The most early sign for the detection of keratoconus was scissor reflex and as the severity of keratoconus increased the central corneal thickness and best corrected visual acuity decreased.

Detection of Cataract and Surgical Outcomes in the Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT)

Abstract:Purpose. To detect rates of cataracts among underserved participants following community-based eye health screenings in Upper Manhattan. Methods. A cluster-randomized controlled trial enrolled 708 participants aged 40 years or older for eye health screenings. Participants with visual acuity (VA) 20/40 or worse, intraocular pressure 23–29 mmHg, or unreadable fundus images in either eye were referred for examination by a study optometrist and subsequent referral for ophthalmologic exam, if warranted. Results. Among 708 participants, 31.4% were diagnosed with cataracts (n=223). Logistic regression showed higher odds of visually significant cataracts with older age (adjusted odds ratio [aOR] = 1.121, 95% CI = 1.065–1.181), VA worse than 20/40 (aOR = 16.393, 95% CI = 3.268–83.333), or an unreadable fundus image (aOR = 333.333, 95% CI = 37.037–∞) (p < .001). Conclusion. Cataract detection in underserved individuals was associated with older age, poor visual acuity, and unreadable fundus images but cataract surgery rates were low.

SIA Vector Analysis and Keratometry Prediction in Temporal SICS with 350 µm Scleral Incision Depth

This study finds a statistically significant difference in vertical keratometry with moderate SIA magnitude, and adds a unique dimension to the literature by explicitly linking a fixed tunnel depth to the SIA vector and keratometric prediction.