Anterior-Segment Swept-Source Ocular Coherence Tomography and Scheimpflug Imaging Agreement for Keratometry and Pupil Measurements in Healthy Eyes

This study examines agreement between the devices Anterion® and Pentacam HR® used for corneal and pupil measurements in healthy eyes. The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), anterior astigmatism (D), anterior K max (D), posterior Km (D), posterior K2 (D), posterior K1 (D), posterior K1 axis (°), posterior astigmatism (D), CCT (µm), thinnest point thickness (µm), thinnest point X-coordinate (mm), thinnest point Y-coordinate (mm), pupil diameter (mm), pupil center-corneal vertex distance (mm) (angle kappa), pupil centroid angle (°), pupil centroid X-coordinate (mm), and pupil centroid Y-coordinate (mm). The Student’s t test for independent samples identified significant differences (p < 0.005) between devices for the measurements anterior and posterior flat K axis, posterior flat K, steep K, and mean K. For these last three measurements, although significant, none of the differences were clinically relevant. Corneal power and thickness measurements except Kf axis showed excellent agreement between Anterion and Pentacam. In a clinical setting we would not recommend the interchangeable use of Pentacam and Anterion for measurement of pupil parameters.

Bilateral Differential Topography—A Novel Topographic Algorithm for Keratoconus and Ectatic Disease Screening

Purpose: The purpose of this study was to establish a novel bilateral differential topographic algorithm and assess its efficacy for screening of keratoconus and corneal ectasia before corneal refractive surgery.Methods: One hundred and sixty-one consecutive patients (115 men and 46 women, aged 22.8 ± 6.8 years) with keratoconus, including clinical keratoconus, subclinical keratoconus, forme fruste keratoconus (FFK), and corneal ectasia (KC group) and one hundred and seventy-four consecutive patients (97 men and 77 women, aged 25.1 ± 6.7 years) with ametropia (control group) visiting the Eye and ENT hospital of Fudan University from June 2018 to April 2021 were included. Bilateral differential keratometry, elevation, and pachymetry topographies were composed based on raw topographic data obtained by a Scheimpflug imaging anterior segment analyzer. Key bilateral differential characteristic parameters were calculated. SPSS 20 (SPSS Inc., IBM) was used for statistical analyses and the receiver operating characteristic (ROC) curves were used to determine the diagnostic efficacies.Results: Mann-Whitney tests detected that the front keratometry, front elevation, corneal pachymetry, and back elevation maximal, mean, and standard deviation values within a 1.5-mm radius of the bilateral differential topography were all significantly higher in the KC group than in the control group (all p-values &lt;0.001). The front keratometry mean (ΔFKmean) and standard deviation (ΔFKsd) and the front elevation standard deviation (ΔFEsd) and maximal (ΔFEmax) values within a 1.5-mm radius of the bilateral differential topography yielded the four highest accuracies (area under the ROC curve = 0.985, 0.985, 0.984, and 0.983, respectively) for discriminating KC cases (including FFK cases) from normal cases. Cut-off values of 0.75 diopters (D) for the ΔFKmean, 0.67 D for the ΔFKsd, 2.9 μm for the ΔFEsd, and 14.6 μm for the ΔFEmax had the highest sensitivities (95.7, 95.0, 96.9, and 95.0%, respectively) and specificities (96.0, 97.7, 94.8, and 95.4%, respectively).Conclusion: Bilateral differential topographic parameters may be efficient for the early detection of keratoconus and corneal ectasia secondary to corneal refractive surgery. This bilateral differential topographic algorithm may complement conventional diagnostic models by improving the sensitivity and specificity of screening for early keratoconus and ectasia before corneal refractive surgeries.

On the Relationship between Corneal Biomechanics, Macrostructure and Optical Properties

Optical properties of the cornea are responsible for correct vision, ultrastructure allows optical transparency and biomechanical properties governs the shape, elasticity or stiffness of the cor-nea affecting ocular integrity and intraocular pressure. Therefore, optical aberrations, corneal transparency, structure and biomechanics play a fundamental role in the optical quality of hu-man vision, ocular health and refractive surgery outcomes. However, the convergence of those properties is not yet reported at macroscopic scale within the hierarchical structure of the cornea. This work explores the relationships between biomechanics, structure and optical properties (corneal aberrations and optical density) at macrostructural level of the cornea through dual Placido-Scheimpflug imaging and air-puff tonometry systems in a healthy young adult popula-tion. Results showed convergence between optical transparency, corneal macrostructure and biomechanics.

Calculation of Toric Intraocular Lens Power with the Barrett Calculator and Data from Three Keratometers

Aim. To investigate the interdevice agreement for differences in toric power calculated using data on anterior corneal astigmatism obtained with corneal topography/ray-tracing aberrometry (iTrace), partial coherence interferometry (IOLMaster 500), and Scheimpflug imaging (Pentacam). Methods. The analysis included 101 eyes (101 subjects) with regular astigmatism. The main outcome measures were corneal cylinder power, axis of astigmatism, and keratometry values. Toricity and toric IOL power were calculated using the online Barrett toric calculator. Interdevice agreement for measurement and calculation was assessed using a paired sample t-test and a nonparametric test. Results. Significant interdevice differences were noted in the magnitude of astigmatism and flat, steep, and mean keratometry values between iTrace and IOLMaster (all P < 0.01 ); in flat, steep, and mean keratometry values (all P < 0.001 ) but not in the magnitude of astigmatism ( P = 0.325 ) between iTrace and Pentacam; and in the magnitude of astigmatism and steep and mean keratometry values (all P < 0.01 ) but not in flat keratometry values ( P = 0.310 ) between IOLMaster and Pentacam. The toric IOL power calculated using data from the three devices showed the following trend: iTrace > IOLMaster (0.49 ± 0.36, P < 0.001 ) and Pentacam (0.39 ± 0.42, P < 0.001 ) and Pentacam was <IOLMaster (−0.10 ± 0.39, P = 0.009 ). There were differences in toricity calculated using data from the three devices ( P = 0.004 ). Conclusions. Differences in toric IOL power and toricity calculated using anterior keratometry data from iTrace, IOLMaster 500, and Pentacam should be noted in clinical practice.

Current Developments in Corneal Topography and Tomography

Introduction: Accurate assessment of the corneal shape is important in cataract and refractive surgery, both in screening of candidates as well as for analyzing postoperative outcomes. Although corneal topography and tomography are widely used, it is common that these technologies are confused. The aim of this study was to present the current developments of these technologies and particularly distinguish between corneal topography and tomography. Methods: The PubMed, Web of Science and Embase databases were the main resources used to investigate the medical literature. The following keywords were used in various combinations: cornea, corneal, topography, tomography, Scheimpflug, Pentacam, optical coherence tomography. Results: Topography is the study of the shape of the corneal surface, while tomography allows a three-dimensional section of the cornea to be presented. Corneal topographers can be divided into large- and small-cone Placido-based devices, as well as devices with color-LEDs. For corneal tomography, scanning slit or Scheimpflug imaging and optical coherence tomography may be employed. In several devices, corneal topography and tomography have been successfully combined with tear-film analysis, aberrometry, optical biometry and anterior/posterior segment optical coherence tomography. Conclusion: There is a wide variety of imaging techniques to obtain corneal power maps. As different technologies are used, it is imperative that doctors involved in corneal surgery understand the science and clinical application of devices for corneal evaluation in depth.