1
|
Chen X, Chen L. Causal Links Between Systemic Disorders and Keratoconus in European Population. Am J Ophthalmol 2024; 265:189-199. [PMID: 38705552 DOI: 10.1016/j.ajo.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To establish the presence of a causal linkage between prevalent systemic diseases and keratoconus (KC). DESIGN Mendelian randomization (MR) analysis. METHODS After an exhaustive screening process, genetic variants linked to various systemic diseases were identified as instrumental variables at the genome-wide significance level. Subsequently, MR analyses were conducted to elucidate their potential causal connection with KC (N = 26,742). The encompassed systemic ailments comprise diabetes, hay fever/allergic rhinitis/eczema, obstructive sleep apnea, thyroid dysfunction, aortic aneurysm, major depressive disorder, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), and mitral valve prolapse. Our study adheres to the principles of Strengthening the Reporting of Observational Studies in Epidemiology Using MR guidelines. RESULTS Using inverse variance weighting as the primary MR analysis method, our findings revealed that hay fever/allergic rhinitis/eczema (odds ratio, 10.144; 95% CI, 2.441-42.149; P = .001) and ulcerative colitis (odds ratio, 1.147; 95% CI, 1.054-1.248; P = .002) were associated with an increased risk of KC within the largest population under scrutiny. Conversely, the prolonged hyperglycemic state did not exhibit a potentially protective effect in delaying the pathogenesis of KC, and no correlation was observed between the two (odds ratio, 0.320; 95% CI, 0.029-3.549; P = .353). Also, obstructive sleep apnea, thyroid function, aortic aneurysm, major depressive disorder, Crohn's disease, and mitral valve prolapse did not exhibit a causal association with KC (P > .05 for all comparisons). CONCLUSIONS This study indicates an increased risk of KC related to hay fever/allergic rhinitis/eczema and ulcerative colitis, with diabetes not providing a protective effect. These findings may potentially contribute some insights to inform clinical interventions.
Collapse
Affiliation(s)
- Xiaxue Chen
- From the Department of Ophthalmology (X.C.), The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Lanlan Chen
- Department of Hepatobiliary and Pancreatic Surgery (L.C.), General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
2
|
Mathan JJ, Gokul A, Simkin SK, Meyer JJ, McGhee CNJ. Keratoconus in Down syndrome: Prevalence, risk factors, severity and corneal tomographic characteristics. Clin Exp Ophthalmol 2024; 52:22-30. [PMID: 37963802 DOI: 10.1111/ceo.14316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND This study investigated the prevalence, risk factors and severity of corneal tomographic features of keratoconus in Down syndrome (DS). Additionally, previous studies indicate anomalous corneal features in DS, without keratoconus, this study characterised corneal features in DS without keratoconus. METHODS This prospective observational study included participants with DS ≥10 years old. Keratoconus diagnosis, risk factors and corneal tomographic characteristics were recorded. Participants underwent slit-lamp biomicroscopy, Scheimpflug corneal tomography, corneal topography and autorefraction. A diagnosis of keratoconus (DS-KC), suspect keratoconus (DS-SK) and non-keratoconus (DS-NK) was made based on expert review of scans by three fellowship trained anterior segment ophthalmologists. Corneal tomography parameters from one eye of each participant were analysed. RESULTS Keratoconus affected 50 (26.3%) of 190 participants, diagnosed by corneal tomography, topography or slit-lamp signs. Corneal hydrops affected 14.0% of DS-KC participants. Eye rubbing was a significant risk factor for keratoconus (p = 0.036). 175 (92%) participants could undertake corneal tomography of which tomography assessment alone identified 47 (26.9%) DS-KC participants, 64 (36.6%) DS-SK participants and 64 (36.6%) DS-NK participants. Significant differences (p < 0.001) were identified when the DS-KC, DS-SK and DS-NK groups were compared in maximum keratometry and posterior elevation at the thinnest point respectively: median (interquartile range) 50.20 (10.30D), 47.60 (1.95D), 46.50 (2.40D); 24.0 (38.00 μm), 10.00 (13.75 μm), 8.00 (6.00 μm). The DS-SK and DS-NK cohorts had similar minimum pachymetry, however, had several significantly different parameters among which included greater maximum keratometry, posterior elevation at the thinnest point in the DS-SK group. CONCLUSIONS Keratoconus is common in DS. Keratoconus screening with corneal tomography is recommended for early detection.
Collapse
Affiliation(s)
- Joyce J Mathan
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Samantha K Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jay J Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Unni P, Lee HJ. Systemic Associations with Keratoconus. Life (Basel) 2023; 13:1363. [PMID: 37374145 DOI: 10.3390/life13061363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Keratoconus is a disease of the cornea that results in progressive steepening and thinning of the cornea and subsequent vision loss. It nearly always presents as a bilateral disease, suggesting that there is an underlying abnormality of the corneas that becomes manifest with time. However, the mechanisms underlying the development of keratoconus are largely unknown. Associations reported between keratoconus and systemic diseases are abundant in the literature, and the list of possible associations is very long. We found that atopy, Down syndrome, and various connective tissue diseases were the most frequently cited associations in our broad literature search. Additionally, Diabetes Mellitus has been increasingly studied as a possible protective factor against keratoconus. In this review, we have summarized the evidence for and against these particular systemic conditions and keratoconus and have discussed some of the implications of keratoconus patients having these conditions.
Collapse
Affiliation(s)
- Prasida Unni
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
| | - Hyunjoo Jean Lee
- Chobanian and Avedisian School of Medicine, Boston University, Boston, MA 02118, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA 02118, USA
| |
Collapse
|
4
|
Toprak I, Cavas F, Velázquez JS, del Barrio JLA, Alio JL. A three-dimensional morpho-volumetric similarity study of Down syndrome keratopathy vs. keratoconus. EYE AND VISION (LONDON, ENGLAND) 2023; 10:4. [PMID: 36593521 PMCID: PMC9809058 DOI: 10.1186/s40662-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND To compare and contrast morpho-volumetric features between Down syndrome (DS) cornea and non-DS keratoconic cornea by three-dimensional (3D) modelling. METHODS Forty-three subjects (43 eyes) with DS and 99 patients matching their age and sex (99 eyes) with keratoconus (KC) were included in this single-center cross-sectional study. Main outcome measures were high-order aberrations (HOA), central corneal thickness (CCT), spherical equivalent refraction, and morpho-volumetric parameters established using a 3D corneal model, such as deviation of anterior and posterior corneal apices (Dapexant/Dapexpost) and minimum thickness points (Dmctant/Dmctpost) from corneal vertex, areas of the anterior and posterior surfaces (Aant/Apost), sagittal area passing through the anterior and posterior corneal apices (Aapexant/Aapexpost) and minimum thickness point (Amctpost) and corneal volume of the complete cornea (Vtotal). RESULTS Age, gender, spherical equivalent refraction, CCT and Vtotal were similar between the net on-DS KC and DS groups (P > 0.05), while non-DS KC group had higher HOA than the DS group (P < 0.05). Dapexant, Aant, Apost and Aapexant showed higher values in the DS group than in the non-DS KC group, whereas Dapexpost showed a reduction in the DS group when compared with the non-DS KC group (P < 0.05). CONCLUSIONS This study demonstrated that anterior and posterior corneal apex dynamics were specifically different in DS subjects, as the anterior apex tends to displace more prominently when compared to that from the non-DS KC group, while the posterior apex appears to be more stable than that in non-DS KC, which also support the theory that DS patients suffer from a specific keratopathy, distinctively different to KC but strongly related to it, and probably showing a diversity of corneal phenotypes in all cases of DS.
Collapse
Affiliation(s)
- Ibrahim Toprak
- grid.411742.50000 0001 1498 3798Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Francisco Cavas
- grid.218430.c0000 0001 2153 2602Bioengineering and Applied Computational Simulation Research Group, Technical University of Cartagena, Cartagena, Spain ,grid.218430.c0000 0001 2153 2602Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, Cartagena, Spain
| | - José S. Velázquez
- grid.218430.c0000 0001 2153 2602Bioengineering and Applied Computational Simulation Research Group, Technical University of Cartagena, Cartagena, Spain ,grid.218430.c0000 0001 2153 2602Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, Cartagena, Spain
| | - Jorge L. Alio del Barrio
- grid.419256.dDepartment of Research and Development, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.419256.dCornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain
| | - Jorge L. Alio
- grid.419256.dDepartment of Research and Development, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.419256.dCornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain
| |
Collapse
|
5
|
Hashemi H, Asgari S. Corneal characteristics in Down syndrome patients with normal and keratoconic cornea. Front Med (Lausanne) 2022; 9:985928. [PMID: 36186827 PMCID: PMC9524572 DOI: 10.3389/fmed.2022.985928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the reference range of corneal indices in Down syndrome patients with normal corneas (DS-N) and to compare it with the corneal indices in Down syndrome patients with keratoconic corneas (DS-KC). Methods A study was conducted using the data of 154 eyes of 154 DS-N and 25 eyes of 25 DS-KC patients. Eighteen indices related to thickness, anterior chamber, keratometry, elevation, and aberrations routinely used for KC diagnosis were extracted from the Pentacam. Results The mean age of the participants in DS-N and DS-KC groups was 16.73 ± 4.70 and 16.56 ± 4.22 years (P = 0.852). In the DS-N group, 95% CI were 511.65–520.31 for minimum corneal thickness, 2.97–3.07 for anterior chamber depth (ACD), 46.83–47.37 for maximum keratometry (Kmax), 46.13–46.62 for zonal Kmax at 3 mm, 0.35–0.58 for inferior-superior asymmetry (I-S value), 1.56–1.88 for Belin/Ambrósio display-total deviation, 8.65–10.79 for best-fit-sphere posterior elevation at the thinnest point, and 0.18–0.22 for corneal vertical coma. The age-related change in I-S value and corneal spherical aberration (SA) was significant (both P < 0.05). There were significant inter-gender differences in 11 indices; the female DS patients had shallower, steeper, more elevated, and more aberrated corneas (all P < 0.05). There were significant differences in all indices except for ACD (P = 0.372) and corneal SA (P = 0.169) between DS-N and DS-KC groups. Conclusion In DS patients aged 10–30 years, the reference ranges of corneal indices are different from the range reported for non-DS subjects and are close to values reported for mild KC non-DS cases. The normal values are different between DS male and female; hence, sex-specific ranges should be considered for diagnosis of corneal abnormality in DS patients.
Collapse
|
6
|
Akoto T, Li JJ, Estes AJ, Karamichos D, Liu Y. The Underlying Relationship between Keratoconus and Down Syndrome. Int J Mol Sci 2022; 23:ijms231810796. [PMID: 36142709 PMCID: PMC9503764 DOI: 10.3390/ijms231810796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.
Collapse
Affiliation(s)
- Theresa Akoto
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Jiemin J. Li
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Amy J. Estes
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2015
| |
Collapse
|
7
|
Hashemi H, Roberts CJ, Ambrósio R, Mehravaran S, Hafezi F, Vinciguerra R, Vinciguerra P, Panahi P, Asgari S. Comparative Contralateral Randomized Clinical Trial of Standard (3 mW/cm 2) Versus Accelerated (9 mW/cm 2) CXL in Patients With Down Syndrome: 3-Year Results. J Refract Surg 2022; 38:381-388. [PMID: 35686709 DOI: 10.3928/1081597x-20220329-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the long-term results of accelerated corneal cross-linking (CXL) (9 mW/cm2, 10 min) with standard CXL (3 mW/cm2, 30 min) in patients with Down syndrome who had keratoconus. METHODS In this contralateral randomized clinical trial, 27 patients with Down syndrome aged 15.78 ± 2.46 years (range: 10 to 19 years) were enrolled. CXL was performed using the KXL System (Avedro, Inc) under general anesthesia, and patients were followed up for 3 years. The main outcome measure was a change in average keratometry in the 3-mm zone around the steepest point (zonal Kmax-3mm). Secondary outcomes were changes in Corvis ST (Oculus Optikgeräte GmbH) biomechanical parameters and vision, refraction, and corneal tomography measurements. RESULTS Mean 3-year changes in zonal Kmax-3mm were not significantly different between the accelerated and standard groups (-0.06 ± 0.75 and -0.35 ± 0.94 diopters [D], respectively, P = .727). Despite the contralateral design of the study, based on most baseline biomechanical indices, corneas in the standard group were weaker before treatment. The standard group also showed significantly fewer 3-year changes in the stress-strain index (-0.11 ± 0.21 vs -0.30 ± 0.32), integrated radius (+0.99 ± 3.48 vs +3.14 ± 2.84), and deformation amplitude ratio-2mm (-1.38 ± 1.33 vs +0.30 ± 1.75) (all P < .0167). Corneal stiffness in the accelerated group was stable for 2 years, and the decline mainly occurred during the third year. CONCLUSIONS In young patients with Down syndrome who had keratoconus, accelerated and standard CXL showed a similar flattening effect. Standard CXL is better able to maintain corneal stiffness in weaker corneas. With accelerated CXL, despite stable results for 2 years, there was decreased corneal stiffness in the third year. Longer follow-up periods are warranted to study the decreased efficacy on keratoconus progression. [J Refract Surg. 2022;38(6):381-388.].
Collapse
|
8
|
Mathan JJ, Simkin SK, Gokul A, McGhee CNJ. Down syndrome and the eye: ocular characteristics and ocular assessment. Surv Ophthalmol 2022; 67:1631-1646. [DOI: 10.1016/j.survophthal.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/20/2023]
|
9
|
Karamichos D, Escandon P, Vasini B, Nicholas SE, Van L, Dang DH, Cunningham RL, Riaz KM. Anterior pituitary, sex hormones, and keratoconus: Beyond traditional targets. Prog Retin Eye Res 2021; 88:101016. [PMID: 34740824 PMCID: PMC9058044 DOI: 10.1016/j.preteyeres.2021.101016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
"The Diseases of the Horny-coat of The Eye", known today as keratoconus, is a progressive, multifactorial, non-inflammatory ectatic corneal disorder that is characterized by steepening (bulging) and thinning of the cornea, irregular astigmatism, myopia, and scarring that can cause devastating vision loss. The significant socioeconomic impact of the disease is immeasurable, as patients with keratoconus can have difficulties securing certain jobs or even joining the military. Despite the introduction of corneal crosslinking and improvements in scleral contact lens designs, corneal transplants remain the main surgical intervention for treating keratoconus refractory to medical therapy and visual rehabilitation. To-date, the etiology and pathogenesis of keratoconus remains unclear. Research studies have increased exponentially over the years, highlighting the clinical significance and international interest in this disease. Hormonal imbalances have been linked to keratoconus, both clinically and experimentally, with both sexes affected. However, it is unclear how (molecular/cellular signaling) or when (age/disease stage(s)) those hormones affect the keratoconic cornea. Previous studies have categorized the human cornea as an extragonadal tissue, showing modulation of the gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Studies herein provide new data (both in vitro and in vivo) to further delineate the role of hormones/gonadotropins in the keratoconus pathobiology, and propose the existence of a new axis named the Hypothalamic-Pituitary-Adrenal-Corneal (HPAC) axis.
Collapse
Affiliation(s)
- Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Lyly Van
- University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA; Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deanna H Dang
- College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
10
|
Jiménez-García M, Kreps EO, Ní Dhubhghaill S, Koppen C, Rozema JJ. Determining the Most Suitable Tomography-Based Parameters to Describe Progression in Keratoconus. The Retrospective Digital Computer Analysis of Keratoconus Evolution Project. Eye Contact Lens 2021; 47:486-493. [PMID: 34050086 DOI: 10.1097/icl.0000000000000800] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To identify the most suitable parameters to describe keratoconus progression. METHODS Longitudinal retrospective cohort study. Monotonicity and consistency of over 250 parameters extracted from the Pentacam tomographies (Oculus, Germany) of 743 patients was analyzed. Repeatability was calculated for 69 patients (published elsewhere). The parameters were scored based on their performance for each desired feature and a global ranking was created. RESULTS Overall, parameters that average a higher number of corneal points performed better than single-point parameters. Zonal keratometries on areas surrounding the maximum curvature point and the steepest front keratometry performed best, followed by front best-fit sphere and mean keratometry of both surfaces. Platform-dependent indices (e.g., Belin-Ambrósio Deviation- or index height decentration-) obtained good scores, but platform-independent LOGIK performed slightly better. Finally, although minimum radius in both surfaces worked competently, minimum pachymetry (PachyMin) performed considerably poorer. CONCLUSIONS We presented a list of parameters whose behavior was repeatable, monotonic and consistent, features desirable to describe change. The parameters normally used to follow keratoconus progression may not be the most adequate, as evidenced by the poor performance of PachyMin. Although calculated for a specific Scheimpflug device, most of the best-performing parameters are platform-independent variables, and results may be generalized, pending validation.
Collapse
Affiliation(s)
- Marta Jiménez-García
- Department of Ophthalmology (M.J.-G., S.N.D., C.K., J.J.R.), Antwerp University Hospital (UZA), Edegem, Belgium ; Department of Medicine and Health Sciences (M.J.-G., E.O.K., S.N.D., C.K., J.J.R.), University of Antwerp, Antwerp, Belgium ; Department of Ophthalmology (E.O.K.), Ghent University Hospital, Ghent, Belgium ; and Department of Medicine and Health Sciences (E.O.K.), University of Ghent, Ghent, Belgium
| | | | | | | | | |
Collapse
|
11
|
Shanthi S, Aruljyothi L, Balasundaram MB, Janakiraman A, Nirmaladevi K, Pyingkodi M. Artificial intelligence applications in different imaging modalities for corneal topography. Surv Ophthalmol 2021; 67:801-816. [PMID: 34450134 DOI: 10.1016/j.survophthal.2021.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/26/2022]
Abstract
Interpretation of topographical maps used to detect corneal ectasias requires a high level of expertise. Several artificial intelligence (AI) technologies have attempted to interpret topographic maps. The purpose of this study is to provide a review of AI algorithms in corneal topography from the perspectives of an eye care professional, a biomedical engineer, and a data scientist. A systematic literature review using Web of Science, Pubmed, and Google Scholar was performed from 2010 to 2020 on themes regarding imaging modalities, their parameters, purpose, and conclusions and their samples and performance related to AI in corneal topography. We provide a comprehensive summary of advances in corneal imaging and its applications in AI. Combined metrics from the Dual Scheimpflug and Placido device could be a good starting point to try AI models in corneal imaging systems. The range of area under the receiving operating curve for AI in keratoconus detection and classification was from 0.87 to 1, sensitivity was from 0.89 to 1, and specificity was from 0.82 to 1. A combination of different types of AI applications to corneal ectasia diagnosis is recommended.
Collapse
Affiliation(s)
- S Shanthi
- Kongu Engineering College, Erode, Tamil Nadu, India.
| | | | | | | | | | - M Pyingkodi
- Kongu Engineering College, Erode, Tamil Nadu, India
| |
Collapse
|
12
|
Kristianslund O, Drolsum L. Prevalence of keratoconus in persons with Down syndrome: a review. BMJ Open Ophthalmol 2021; 6:e000754. [PMID: 33981858 PMCID: PMC8061858 DOI: 10.1136/bmjophth-2021-000754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Keratoconus is a vision-threatening condition, and there is a need for knowledge about the occurrence in subgroups of the population. The progression of the disease can be effectively stopped, and vision may be restored, if keratoconus is diagnosed at an early stage. The purpose of this review was to evaluate the literature of the prevalence of keratoconus in persons with Down syndrome. Methods We conducted a literature review of keratoconus prevalence in persons with Down syndrome. A thorough search was performed in Pubmed (Medline), and the quality of evidence was evaluated. Results The literature review identified 20 relevant studies, which reported keratoconus in 0%–71% of persons with Down syndrome. These studies varied greatly in design, patient selection, sample sizes and mean age, and the quality of evidence concerning estimates for the prevalence of keratoconus was generally evaluated as low. Most studies that included adults reported high prevalences of keratoconus–in many studies more than 10-fold the prevalence in the general population. No large screening studies in persons with Down syndrome were identified. Conclusions The present review showed that the prevalence of keratoconus in persons with Down syndrome is higher than in the general population. However, estimates from previous studies vary widely. Screening for keratoconus in this group should be considered.
Collapse
Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
13
|
Toprak I, Cavas F, Vega A, Velázquez JS, Alio del Barrio JL, Alio JL. Evidence of a Down Syndrome Keratopathy: A Three-Dimensional (3-D) Morphogeometric and Volumetric Analysis. J Pers Med 2021; 11:jpm11020082. [PMID: 33573177 PMCID: PMC7911434 DOI: 10.3390/jpm11020082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to investigate whether a different and abnormal corneal profile is present in Down syndrome (DS) by personalized three-dimensional (3D) modelling. This single-centre cross-sectional study included 43 patients with DS (43 eyes) and 58 age-sex-matched control subjects (58 eyes) with normal karyotype and topography. Refraction, central corneal thickness (CCT), aberrations (high-order, coma and spherical), asphericity and morphogeometric/volumetric parameters based on a 3D corneal model that was generated from raw topographical data were evaluated. Deviation of anterior/posterior apex (Dapexant/Dapexpost) and thinnest point (Dmctant/Dmctpost) from corneal vertex, anterior/posterior surface area (Aant/Apost), sagittal area passing through the anterior/posterior apex (Aapexant/Aapexpost) and thinnest point (Amctpost), total corneal volume (Vtotal) and volumetric progression for each 0.05 mm step of the radius value centred to the thinnest point (VOLMCT) and anterior/posterior apex (VOLAAP/VOLPAP) comprised the morphogeometric/volumetric parameters. In the DS group, 58.1% of the eyes presented abnormal topography. High-order and coma aberrations, asphericity, Dapexant, Aant, Apost and Aapexant were significantly higher, whereas CCT, Aapexpost, Amctpost, Vtotal, VOLAAP, VOLPAP and VOLMCT were lower in the DS group than in the control group (p < 0.05). Dapexpost did not differ between the groups (p > 0.05). This study demonstrates that corneas of the subjects with DS are different and more aberrated than those of normal age- and sex-matched non-DS controls. Anterior corneal apex appears to be displaced in DS even with normal topography, while posterior apex seems stable although topography is abnormal. These findings may help to modify our approach in the diagnosis of keratopathy in subjects with DS.
Collapse
Affiliation(s)
- Ibrahim Toprak
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
- Correspondence: ; Tel.: +34-968-338-856
| | - Alfredo Vega
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| | - José S. Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - Jorge L. Alio del Barrio
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| | - Jorge L. Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| |
Collapse
|
14
|
Asgari S, Mehravaran S, Aghamirsalim M, Hashemi H. Tomography-based definition of keratoconus for Down syndrome patients. EYE AND VISION 2020; 7:49. [PMID: 33029546 PMCID: PMC7534157 DOI: 10.1186/s40662-020-00215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023]
Abstract
Background To assess the diagnostic ability of Pentacam HR (Oculus Optikgeräte, GmbH, Wetzlar, Germany) tomographic indices in discriminating keratoconus (KC) and KC suspect (KCS) in 10- to 30-year-old patients with Down syndrome (DS). Methods In this study, DS patients were enrolled through special needs schools, the National Down Syndrome Society, and relevant non-profit organizations. Diagnoses were made independently by two experienced specialists. Forty Pentacam indices related to corneal thickness, volume, density, keratometry, power, shape, aberration, and elevation were extracted. For each index, the accuracy for KC and KCS diagnosis was evaluated using discriminant analysis and the area under receiver operating characteristic curve (AUROC). From each enrolled case, data from only one eye was entered in the analyses. Results Analyses were performed on data from 25 KC, 46 KCS, and 154 non-ectatic DS eyes. The best discriminants for KC were anterior higher order aberrations (HOA) (cutoff > 0.643, AUROC = 0.879), posterior vertical coma (cutoff > 0.0702 μm, AUROC = 0.875), anterior vertical coma (cutoff > 0.4124 μm, AUROC = 0.868), and total HOA (cutoff > 0.608, AUROC = 0.867). The difference between AUROCs were not statistically significant (all P > 0.05). For KCS, the best discriminants were minimum corneal thickness (cutoff ≤ 480.0 μm, AUROC = 0.775), corneal volume (cutoff ≤ 55.3 μm, AUROC = 0.727) and Belin Ambrosio display-total deviation (BAD-D) (cutoff > 2.23, AUROC = 0.718) with no significant difference between AUROCs (all P > 0.05). Conclusions In this sample of DS patients, best KC discriminators were HOA and coma which showed good diagnostic ability. For KCS, best predictors were minimum corneal thickness, corneal volume, and BAD-D with relatively good diagnostic ability. Defining a new set of KC diagnostic criteria for DS patients is suggested.
Collapse
Affiliation(s)
- Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| | - Shiva Mehravaran
- ASCEND Center for Biomedical Research, Morgan State University, Baltimore, MD USA
| | | | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran
| |
Collapse
|
15
|
Hashemi H, Amanzadeh K, Seyedian M, Zeraati H, Roberts CJ, Mehravaran S, Ambrósio R, Vinciguerra R, Vinciguerra P, Asgari S. Accelerated and Standard Corneal Cross-Linking Protocols in Patients with Down Syndrome: A Non-inferiority Contralateral Randomized Trial. Ophthalmol Ther 2020; 9:1011-1021. [PMID: 33006120 PMCID: PMC7708533 DOI: 10.1007/s40123-020-00303-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction To compare the results of an accelerated corneal cross-linking (CXL) protocol (9 mW/cm2, 10 min) with the standard CXL protocol (3 mW/cm2, 30 min) in patients with Down syndrome (DS) who have keratoconus (KC). Methods Twenty-seven 10- to 20-year-old patients with DS who had bilateral progressive KC were enrolled in a contralateral randomized trial and completed 2 years of follow-up examinations. Fellow eyes were randomly allocated to the accelerated CXL group or the standard CXL group. The main outcome measure was change in maximum keratometry (Kmax) centered on the steepest point (zonal Kmax − 3 mm) with a non-inferiority margin of 1.0 diopter (D). Vision and refraction tests, ophthalmic examinations, and corneal tomography were performed at baseline and at 6, 12, and 24 months after CXL. Failure was defined as an increase of ≥ 1.0 D in zonal Kmax − 3 mm within a 12-month period. Results The mean age (± standard deviation) of the patients was 15.71 ± 2.40 years. The within-group change in zonal Kmax − 3 mm was not significant after 2 years in either group, and within-group zonal Kmax − 3 mm remained stable. At 2 years after CXL, the mean change in the zonal Kmax − 3 mm was – 0.02 ± 0.81 D and – 0.31 ± 0.86 D in the accelerated CXL and standard CXL groups, respectively (P = 0.088). At 1 year of follow-up, three patients in the accelerated CXL group showed treatment failure (mean change in zonal Kmax − 3 mm + 2.12 ± 0.11 D); no patients in the standard CXL group showed treatment failure. At 2 years of follow-up, these three patients showed a decrease of – 0.43 ± 0.18 D in zonal Kmax − 3 mm from a baseline value of 55.11 ± 0.32 D. The 2-year trends of the inferior–superior asymmetry and vertical coma were statistically significantly different between the two groups, with the accelerated CXL protocol showing superiority in patients with higher baseline values. Conclusion In young patients with Down syndrome, the accelerated CXL protocol was able to halt disease progression and may be an alternative for the standard CXL protocol. In advanced KC, the efficacy of the accelerated approach was delayed and appeared later in the follow-up. In asymmetric cornea, the accelerated CXL resulted in centralization of the corneal cone. Trial Registration Iranian Registry of Clinical Trials, IRCT20100706004333N3 Electronic supplementary material The online version of this article (10.1007/s40123-020-00303-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Kazem Amanzadeh
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Mohammad Seyedian
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Cynthia J Roberts
- Department of Ophthalmology and Visual Science, The Ohio State University, Columbus, OH, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Shiva Mehravaran
- ASCEND Center for Biomedical Research, Morgan State University, Baltimore, MD, USA
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, RJ, Brazil.,Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research, Rozzano, Italy
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
| |
Collapse
|
16
|
Mathan JJ, Gokul A, Simkin SK, Meyer JJ, Patel DV, McGhee CNJ. Topographic screening reveals keratoconus to be extremely common in Down syndrome. Clin Exp Ophthalmol 2020; 48:1160-1167. [DOI: 10.1111/ceo.13852] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Joyce J. Mathan
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Samantha K. Simkin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Jay J. Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Dipika V. Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| |
Collapse
|
17
|
Asgari S, Aghamirsalim M, Mehravaran S, Hashemi H. Effect of Down syndrome and keratoconus on corneal density and volume: a triple comparative study. Sci Rep 2020; 10:9098. [PMID: 32499561 PMCID: PMC7272627 DOI: 10.1038/s41598-020-66108-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
Keratoconus (KCN) and Down syndrome affect the corneal density and volume. In this study included Down syndrome patients with and without KCN (24 Down-KCN and 204 Down-nonKCN eyes) and normal age- and gender-matched individuals (184 eyes). Studied parameters were the corneal density measured with Pentacam HR in 5 concentric zones and annuli (0-2 mm, 2-6 mm, 6-10 mm, 10-12 mm, and 0-12 mm) in 4 different depth layers (anterior 120 µm, posterior 60 µm, middle layer, and the full thickness of the cornea), and the 10 mm zone corneal volume. In Down-KCN, Down-nonKCN, and control groups, respectively, mean full thickness density in the 0-12 mm zone was 19.35 ± 2.92, 17.85 ± 2.55, and 15.78 ± 2.67 GSU, and mean corneal volume was 57.45 ± 4.37, 56.99 ± 3.46, and 61.43 ± 3.42mm3. All density readings were significantly different between the three studied groups (all P < 0.01) except full thickness density in 0-2 mm and 2-6 mm (P > 0.05) and corneal volume (P = 0.519) between Down-KCN and Down-nonKCN groups; these inter-group densitometry differences within the 6 mm zone were only in the middle layer, and not the anterior or posterior thickness layers (all P > 0.05). Corneal density increased with age and corneal thickness, but there was no significant relationship with gender. Overall, Down syndrome is associated with increased density and light scatter in all corneal layers up to the 12 mm diameter. In Down patients with KCN, the increased light scatter and density in the 6 mm zone is only in the middle thickness layer. Corneal volume is reduced in Down syndrome irrespective of the presence or absence of KCN.
Collapse
Affiliation(s)
- Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | | | - Shiva Mehravaran
- ASCEND Center for Biomedical Research, Morgan State University, Baltimore, MD, USA
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
| |
Collapse
|