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Erdinest N, London N, Landau D, Barbara R, Barbara A, Naroo SA. Higher order aberrations in keratoconus. Int Ophthalmol 2024; 44:172. [PMID: 38594548 DOI: 10.1007/s10792-024-03118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Keratoconus is a progressive disorder of the cornea that causes thinning (Sedaghat et al. in Sci Rep 11(1):11971, 2021), ectasia, and irregular astigmatism, resulting in poor visual acuity that cannot be corrected with standard sphero-cylindrical spectacle lenses. One feature distinguishing keratoconic corneas is ocular aberrations, manifesting up to five or six times the amount of higher-order aberrations than a normal, healthy eye. These aberrations can cause visual disturbances even at the very early stages of the disease. METHODS In the past, a diagnosis was derived from clinical symptoms, but technological advances have revealed multiple pre-clinical features, allowing for the differentiation between keratoconic and normal eyes at a much earlier stage. These include anterior and posterior corneal surface elevations, the corneal pachymetry profile, corneal epithelial patterns, wavefront aberration metrics, and corneal biomechanics (Sedaghat et al. in Sci Rep 11(1):11971, 2021).This review discusses the aberrations associated with keratoconus, how to measure them, and treatment methods to minimize their negative influence. CONCLUSIONS Early diagnosis can lead to early treatment and may allow for arresting progression, thereby improving the long-term prognosis. With the acceleration of refractive surgery, it is important to identify patients with keratoconus, as they are usually contraindicated for refractive surgery.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - David Landau
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ramez Barbara
- Ophthalmology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adel Barbara
- IVISION Cornea and Refractive Surgery Center, Haifa, Israel
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
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Randleman JB, Zhang H, Asroui L, Tarib I, Dupps WJ, Scarcelli G. Subclinical Keratoconus Detection and Characterization Using Motion-Tracking Brillouin Microscopy. Ophthalmology 2024; 131:310-321. [PMID: 37839561 PMCID: PMC11117393 DOI: 10.1016/j.ophtha.2023.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE To characterize focal biomechanical alterations in subclinical keratoconus (SKC) using motion-tracking (MT) Brillouin microscopy and evaluate the ability of MT Brillouin metrics to differentiate eyes with SKC from normal control eyes. DESIGN Prospective cross-sectional study. PARTICIPANTS Thirty eyes from 30 patients were evaluated, including 15 eyes from 15 bilaterally normal patients and 15 eyes with SKC from 15 patients. METHODS All patients underwent Scheimpflug tomography and MT Brillouin microscopy using a custom-built device. Mean and minimum MT Brillouin values within the anterior plateau region and anterior 150 μm were generated. Scheimpflug metrics evaluated included inferior-superior (IS) value, maximum keratometry (Kmax), thinnest corneal thickness, asymmetry indices, Belin/Ambrosio display total deviation, and Ambrosio relational thickness. Receiver operating characteristic (ROC) curves were generated for all Scheimpflug and MT Brillouin metrics evaluated to determine the area under the ROC curve (AUC), sensitivity, and specificity for each variable. MAIN OUTCOME MEASURES Discriminative performance based on AUC, sensitivity, and specificity. RESULTS No significant differences were found between groups for age, sex, manifest refraction spherical equivalent, corrected distance visual acuity, Kmax, or KISA% index. Among Scheimpflug metrics, significant differences were found between groups for thinnest corneal thickness (556 μm vs. 522 μm; P < 0.001), IS value (0.29 diopter [D] vs. 1.05 D; P < 0.001), index of vertical asymmetry (IVA; 0.10 vs. 0.19; P < 0.001), and keratoconus index (1.01 vs. 1.05; P < 0.001), and no significant differences were found for any other Scheimpflug metric. Among MT Brillouin metrics, clear differences were found between control eyes and eyes with SKC for mean plateau (5.71 GHz vs. 5.68 GHz; P < 0.0001), minimum plateau (5.69 GHz vs. 5.65 GHz; P < 0.0001), mean anterior 150 μm (5.72 GHz vs. 5.68 GHz; P < 0.0001), and minimum anterior 150 μm (5.70 GHz vs. 5.66 GHz; P < 0.001). All MT Brillouin plateau and anterior 150 μm mean and minimum metrics fully differentiated groups (AUC, 1.0 for each), whereas the best performing Scheimpflug metrics were keratoconus index (AUC, 0.91), IS value (AUC, 0.89), and IVA (AUC, 0.88). CONCLUSIONS Motion-tracking Brillouin microscopy metrics effectively characterize focal corneal biomechanical alterations in eyes with SKC and clearly differentiated these eyes from control eyes, including eyes that were not differentiated accurately using Scheimpflug metrics. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- J Bradley Randleman
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
| | | | - Lara Asroui
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Imane Tarib
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - William J Dupps
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Giuliano Scarcelli
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland
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Jiang L, Du Z, Tang C, Zhu S, Xiong L, Fang X, Zhou J, Zhang Q, Sun W, Zeng Q, Lei X, Wang Z, Hu Y. Ocular biometrics in eyes with different white-to-white corneal diameter in young myopic adults. Sci Rep 2024; 14:4720. [PMID: 38413741 PMCID: PMC10899605 DOI: 10.1038/s41598-024-55318-9] [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: 06/21/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
The interactions between white-to-white corneal diameter (WTW) and other ocular biometrics are important for planning of refractive surgery and understanding of ocular structural changes in myopia, but such interactions are rarely investigated in young myopic adults. This is a retrospective study involving 7893 young myopic adults from five centers. WTW and other ocular biometrics were measured by Pentacam. The ocular biometrics included anterior corneal curvature (AK) and posterior corneal curvature (PK), central corneal thickness (CCT) and corneal volume (CV), anterior and corneal eccentricity and asphericity, anterior corneal astigmatism (ACA) and posterior corneal astigmatism, anterior chamber depth (ACD), and anterior chamber volume (ACV). The ocular biometrics were compared among eyes of different WTW quartiles. Multivariate linear regression was used to assess the linear associations between WTW and other ocular biometrics adjusting for age, gender and spherical equivalent. In eyes of different WTW quartiles, other ocular biometrics were also significantly different (all P < 0.05). After adjusting for age, gender and spherical equivalent, WTW was positively correlated to AK (β = 0.26 to 0.29), ACA (β = 0.13), anterior corneal asphericity (β = 0.05), PK (β = 0.33 to 0.34), posterior corneal asphericity (β = 0.13), ACD (β = 0.29), and ACV (β = 40.69), and was negatively correlated to CCT (β = - 6.83), CV (β = - 0.06 to - 0.78), anterior corneal eccentricity (β = - 0.035), and posterior corneal eccentricity (β = - 0.14) (all P < 0.001). In conclusion, we found that in young myopic adults, larger WTW was associated with thinner corneal thickness, flatter corneal curvature, more anterior corneal toricity, less corneal eccentricity and asphericity, and broader anterior chamber. Our findings may fill in the gap of literature, and help us better understand how the anterior segment structures interact with the WTW in myopia.
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Affiliation(s)
- Li Jiang
- Refractive Surgery Center, Hankou Aier Eye Hospital, Wuhan, China
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, Hubei Province, China
| | - Zijing Du
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Changting Tang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shanqing Zhu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Lu Xiong
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Xuejun Fang
- Refractive Surgery Center, Shenyang Aier Eye Hospital, Shenyang, China
| | - Jin Zhou
- Refractive Surgery Center, Chengdu Aier Eye Hospital, Chengdu, China
| | - Qingsong Zhang
- Refractive Surgery Center, Wuhan Aier Eye Hospital, Wuhan, China
| | - Wei Sun
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qingyan Zeng
- Refractive Surgery Center, Hankou Aier Eye Hospital, Wuhan, China
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, Hubei Province, China
| | - Xiaohua Lei
- Refractive Surgery Center, Hankou Aier Eye Hospital, Wuhan, China.
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), Wuhan, Hubei Province, China.
| | - Zheng Wang
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.
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Chen L, Chen X, Li F, Liu Z. Refractive surprise of irregular astigmatism following cataract surgery in two patients with neglected subclinical corneal ectasia: two case reports. BMC Ophthalmol 2023; 23:239. [PMID: 37248492 DOI: 10.1186/s12886-023-02984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Corneal ectatic diseases are a group of corneal disorder characterized by the steepening and thinning of the cornea. Older people are not a high-risk population for corneal ectatic diseases; due to the lack of typical preoperative topographic manifestations, there is a high possibility that corneal ectasia is undetected. CASE PRESENTATION Two patients with subclinical corneal ectasia and senile cataracts presented with irregular astigmatism after steep-axis incision during cataract surgery. The two cases presented in this case report are rare because both patients experienced tremendous changes in astigmatism after cataract surgery. CONCLUSION This case report may shed some light on astigmatism-correcting steep-axis incisions in cataract surgeries.
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Affiliation(s)
- Leran Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing key laboratory of restoration of damaged ocular nerve, Beijing, 100191, China
| | - Xiaoyong Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing key laboratory of restoration of damaged ocular nerve, Beijing, 100191, China
| | - Fanshu Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing key laboratory of restoration of damaged ocular nerve, Beijing, 100191, China
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing key laboratory of restoration of damaged ocular nerve, Beijing, 100191, China.
- Peking University Institute of Laser Medicine, Beijing, China.
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Zhang X, Ding L, Sun L, Huang Y, Han T, Qian Y, Zhou X. Prognostic Nomograms Predicting Risk of Keratoconus in Very Asymmetric Ectasia: Combined Corneal Tomographic and Biomechanical Assessments. Front Bioeng Biotechnol 2022; 10:839545. [PMID: 35252147 PMCID: PMC8892177 DOI: 10.3389/fbioe.2022.839545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the study was to develop and validate a prognostic nomogram for subclinical keratoconus diagnosis using corneal tomographic and biomechanical integration assessments.Design: This is a retrospective case–control study.Methods:Setting: The study was carried out in a hospital setting. Patients: The study included patients with very asymmetric ectasia (VAE) and normal controls. Patients with VAE had defined clinical ectasia in one eye and normal topography (VAE-NT) in the fellow eye, and VAE-NT eyes were selected for analysis. VAE-NT was defined as stratified stage 0 using the ABCD keratoconus grading system. The normal control group was selected from corneal refractive surgery candidates at our clinic, and the right eye was enrolled. Observation Procedures: Scheimpflug-based corneal tomography (Pentacam) and corneal biomechanical assessment (Corvis ST) were performed. Main Outcome Measures: We performed multiple logistic regression analysis and constructed a simple nomogram via the stepwise method. The receiver operating characteristic (ROC) curve and discrimination and calibration of prognostic nomogram were performed by 500 bootstrap resamplings to assess the determination and clinical value, respectively.Results: A total of 59 VAE-NT and 142 normal eyes were enrolled. For differentiating normal and VAE-NT eyes, the values of specificity, sensitivity, and area under the ROC (AUROC) were 0.725, 0.610, and 0.713 for tomographic parameters, 0.886, 0.632, and 0.811 for biomechanical parameters, and 0.871, 0.754, and 0.849 for combined parameters, respectively. Combined parameters showed better predictability than separated tomographic or biomechanical parameters.Conclusion: Our nomogram developed with combined tomographic and biomechanical parameters demonstrated a plausible, capable, and widely implementable tool to predict risk of keratoconus. The identification of at-risk patients can provide advanced strategies to epitomize ectasia susceptibility.
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Affiliation(s)
- Xiaoyu Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Lan Ding
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Ling Sun
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yangyi Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Tian Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yishan Qian
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Yishan Qian, ; Xingtao Zhou,
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Yishan Qian, ; Xingtao Zhou,
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