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Journal of cataract and refractive surgery
Feb, 2016;42 (2): 284-95.

Subclinical keratoconus detection by pattern analysis of corneal and epithelial thickness maps with optical coherence tomography.

Yan Li, Winston Chamberlain, Ou Tan, Robert Brass, Jack L Weiss, David Huang
Author Information
  1. Yan Li: From the Center for Ophthalmic Optics and Lasers (Li, Chamberlain, Tan, Huang), Casey Eye Institute, and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, the Brass Eye Center (Brass), Latham, New York, and the Gordon Weiss Schanzlin Vision Institute (Weiss), San Diego, California, USA. Electronic address: liyan@ohsu.edu.
  2. Winston Chamberlain: From the Center for Ophthalmic Optics and Lasers (Li, Chamberlain, Tan, Huang), Casey Eye Institute, and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, the Brass Eye Center (Brass), Latham, New York, and the Gordon Weiss Schanzlin Vision Institute (Weiss), San Diego, California, USA.
  3. Ou Tan: From the Center for Ophthalmic Optics and Lasers (Li, Chamberlain, Tan, Huang), Casey Eye Institute, and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, the Brass Eye Center (Brass), Latham, New York, and the Gordon Weiss Schanzlin Vision Institute (Weiss), San Diego, California, USA.
  4. Robert Brass: From the Center for Ophthalmic Optics and Lasers (Li, Chamberlain, Tan, Huang), Casey Eye Institute, and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, the Brass Eye Center (Brass), Latham, New York, and the Gordon Weiss Schanzlin Vision Institute (Weiss), San Diego, California, USA.
  5. Jack L Weiss: From the Center for Ophthalmic Optics and Lasers (Li, Chamberlain, Tan, Huang), Casey Eye Institute, and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, the Brass Eye Center (Brass), Latham, New York, and the Gordon Weiss Schanzlin Vision Institute (Weiss), San Diego, California, USA.
  6. David Huang: From the Center for Ophthalmic Optics and Lasers (Li, Chamberlain, Tan, Huang), Casey Eye Institute, and Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, the Brass Eye Center (Brass), Latham, New York, and the Gordon Weiss Schanzlin Vision Institute (Weiss), San Diego, California, USA.
PMID: 27026454 DOI: 10.1016/j.jcrs.2015.09.021

Abstract

PURPOSE: To screen for subclinical keratoconus by analyzing corneal, epithelial, and stromal thickness map patterns with Fourier-domain optical coherence tomography (OCT).
SETTING: Four centers in the United States.
DESIGN: Cross-sectional observational study.
METHODS: Eyes of normal subjects, subclinical keratoconus eyes, and the topographically normal eye of a unilateral keratoconus patient were studied. Corneas were scanned using a 26,000 Hz Fourier-domain OCT system (RTVue). Normal subjects were divided into training and evaluation groups. Corneal, epithelial, and stromal thickness maps and derived diagnostic indices, including pattern standard deviation (PSD) variables and pachymetric map-based keratoconus risk scores, were calculated from the OCT data. Area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the diagnostic accuracy of the indices.
RESULTS: The study comprised 150 eyes of 83 normal subjects, 50 subclinical keratoconus eyes of 32 patients, and 1 topographically normal eye of a unilateral keratoconus patient. Subclinical keratoconus was characterized by inferotemporal thinning of the cornea, epithelium, and stroma. The PSD values for corneal (P < .001), epithelial (P < .001), and stromal (P = .049) thickness maps were all significantly higher in subclinical keratoconic eyes than in the normal group. The diagnostic accuracy was significantly higher for PSD variables (pachymetric PSD, AUC = 0.941; epithelial PSD, AUC = 0.985; stromal PSD, AUC = 0.924) than for the pachymetric map-based keratoconus risk score (AUC = 0.735).
CONCLUSIONS: High-resolution Fourier-domain OCT could map corneal, epithelial, and stromal thicknesses. Corneal and sublayer thickness changes in subclinical keratoconus could be detected with high accuracy using PSD variables. These new diagnostic variables might be useful in the detection of early keratoconus.
FINANCIAL DISCLOSURES: Oregon Health and Science University (OHSU) and Drs. Li, Tan, and Huang have a significant financial interest in Optovue, Inc. These potential conflicts have been reviewed and managed by OHSU. Dr. Brass receives research grants from Optovue, Inc. Drs. Chamberlain and Weiss have no financial or proprietary interest in any material or method mentioned.

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Grants

  1. R01 EY018184/NEI NIH HHS
  2. R01EY018184/NEI NIH HHS

MeSH Term

Adult
Aged
Corneal Pachymetry
Corneal Stroma
Corneal Topography
Cross-Sectional Studies
Epithelium, Corneal
Female
Fourier Analysis
Healthy Volunteers
Humans
Keratoconus
Male
Middle Aged
ROC Curve
Reproducibility of Results
Sensitivity and Specificity
Tomography, Optical Coherence
Young Adult
Journal Article Multicenter Study Observational Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

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