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Lwowski C, Krüger D, Kohnen T. Repeatability and agreement of two ocular biometers with single and dual Scheimpflug cameras in keratoconus eyes. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06511-z. [PMID: 39046518 DOI: 10.1007/s00417-024-06511-z] [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: 06/13/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND To evaluate the repeatability and agreement of two different ocular biometers and Scheimpflug devices in keratoconus eyes. METHODS This prospective, comparative trial took place at the University hospital, Goethe University, Frankfurt am Main, Germany. We included eyes with keratoconus, one eye per patient, randomly selected. Measurements were taken with Galilei G6 (Ziemer, Switzerland) and Pentacam AXL (Oculus, Germany), three consecutive measurements each. Repeatability and agreement were evaluated for simulated keratometry (simK), astigmatism (simA), maximum keratometry (KMax) and its axis, total keratometry (TCP), axial length (AL), anterior chamber depth (ACD), and thinnest pachymetry (TCT). RESULTS Both devices showed an excellent repeatability with intra class correlation (ICC) of > 0.97 for all parameters. The 95% limits of repeatability (LoR95%) and agreement (LoA95%) were narrow for all parameters. The Galilei G6 had a narrower LoAR95% for TCT (2.1 μm vs. 4.6 μm), but a wider LoR95% for KMax (0.52D vs. 1.18D). No relevant difference was found for the other parameters. Agreement between the devices was good to moderate, especially for simK and TCP. CONCLUSIONS Both devices show excellent repeatability with narrow LoR95% and high ICC for all parameters. The only relevant difference was found for KMax and TCT in favor of Pentacam AXL and Galilei G6, respectively. Agreement was good to moderate, and most parameters should not be considered interchangeable.
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Affiliation(s)
- Christoph Lwowski
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Daniel Krüger
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Abicca I, Schiano-Lomoriello D, Gilardi M, Giannini D, Dinu V, Coutinho C, Savini G. Repeatability of Automatic Measurements by an Anterior Segment Swept-Source OCT Biometer in Patients With Keratoconus. J Refract Surg 2024; 40:e445-e452. [PMID: 39007818 DOI: 10.3928/1081597x-20240514-03] [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: 07/16/2024]
Abstract
PURPOSE To evaluate the repeatability of automatic measurements of a new anterior segment optical coherence tomographer (ANTERION; Heidelberg Engineering) and their agreement with an anterior segment optical coherence tomography device combined with Placido disc corneal topography (MS-39; CSO) in patients affected by keratoconus. METHODS Fifty-four consecutive patients were included. Three measurements were performed with the ANTERION and one with the MS-39. Repeatability was assessed by means of within-subject standard deviation, coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Agreement was investigated with the 95% limits of agreement. The paired t-test and Wilcoxon matched-pairs test were performed to compare the measurements of the different devices. RESULTS Repeatability of ANTERION measurements was high, with an ICC greater than 0.98 for all parameters. Many parameters revealed a CoV of less than 1% and a CoV within 5% was obtained for astigmatism measurements. The ANTERION measured a significantly higher corneal power and the MS-39 more negative posterior keratometric values. These differences were mirrored by a moderate agreement for mean simulated keratometry and poor agreement for total corneal power and posterior keratometry. CONCLUSIONS The ANTERION revealed high repeatability of automatic measurements and good agreement with the MS-39 for many parameters in patients affected by keratoconus, but for most parameters the two instruments cannot be considered interchangeable. [J Refract Surg. 2024;40(7):e445-e452.].
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Roszkowska AM, Scorcia V, Mencucci R, Giannaccare G, Lombardo G, Alunni Fegatelli D, Vestri A, Bifezzi L, Bernava GM, Serrao S, Lombardo M. Assessment of the Predictive Ability of Theranostics for Corneal Cross-linking in Treating Keratoconus: A Randomized Clinical Trial. Ophthalmology 2024:S0161-6420(24)00367-1. [PMID: 38908553 DOI: 10.1016/j.ophtha.2024.06.012] [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: 03/16/2024] [Revised: 05/29/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE To validate the ability of theranostic imaging biomarkers in assessing corneal cross-linking (CXL) efficacy in flattening the maximum keratometry (Kmax) index. DESIGN Prospective, randomized, multicenter, masked clinical trial (ClinicalTrails.gov identifier, NCT05457647). PARTICIPANTS Fifty patients with progressive keratoconus. INTERVENTION Participants were stratified to undergo epithelium-off (25 eyes) and epithelium-on (25 eyes) CXL protocols using an ultraviolet A (UV-A) medical device with theranostic software. The device controlled UV-A light both for performing CXL and assessing the corneal riboflavin concentration (riboflavin score) and treatment effect (theranostic score). A 0.22% riboflavin formulation was applied onto the cornea for 15 minutes and 20 minutes in epithelium-off and epithelium-on protocols, respectively. All eyes underwent 9 minutes of UV-A irradiance at 10 mW/cm2. MAIN OUTCOME MEASURES The primary outcome measure was validation of the combined use of theranostic imaging biomarkers through measurement of their accuracy (proportion of correctly classified eyes) and precision (positive predictive value) to classify eyes correctly and predict a Kmax flattening at 1 year after CXL. Other outcome measures included change in Kmax, endothelial cell density, uncorrected and corrected distance visual acuity, manifest spherical equivalent refraction and central corneal thickness 1 year after CXL. RESULTS Accuracy and precision of the theranostic imaging biomarkers in predicting eyes that had >0.1 diopter (D) of Kmax flattening at 1 year were 91% and 95%, respectively. The Kmax value significantly flattened by a median of -1.3 D (IQR, -2.11 to -0.49 D; P < 0.001); both the uncorrected and corrected distance visual acuity improved by a median of -0.1 logarithm of the minimum angle of resolution (logMAR; IQR, -0.3 to 0.0 logMAR [P < 0.001] and -0.2 to 0.0 logMAR [P < 0.001], respectively). No significant changes in endothelial cell density (P = 0.33) or central corneal thickness (P = 0.07) were noted 1 year after surgery. CONCLUSIONS The study demonstrated the efficacy of integrating theranostics in a UV-A medical device for the precise and predictive treatment of keratoconus with epithelium-off and epithelium-on CXL protocols. Concentration of riboflavin and its UV-A light mediated photoactivation in the cornea are the primary factors determining CXL efficacy. 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)
- Anna Maria Roszkowska
- Ophthalmology Unit, Gaetano Martino Hospital, University of Messina, Messina, Italy; Department of Ophthalmology, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Vincenzo Scorcia
- Ophthalmology Unit, Renato Dulbecco Hospital, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rita Mencucci
- Ophthalmology Unit, Careggi Hospital, University of Firenze, Firenze, Italy
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, University of Roma "La Sapienza," Rome, Italy; Department of Life Sciences, Health and Health Professions, Link Campus University, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, University of Roma "La Sapienza," Rome, Italy
| | - Luca Bifezzi
- Ophthalmology Unit, Renato Dulbecco Hospital, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Shah Z, Purohit D, Danayak P. Keratoconus characteristics and associations: A cross-sectional keratoconus study in western India (CKSWI). Indian J Ophthalmol 2024; 72:704-711. [PMID: 38324266 PMCID: PMC11168558 DOI: 10.4103/ijo.ijo_1069_23] [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: 04/24/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE To study the clinical and tomographic characteristics and associations of keratoconus (KC) patients visiting a tertiary eye care hospital. METHODS This was a cross-sectional, observational study that included 242 newly diagnosed clinical KC patients. Detailed ocular and systemic history, visual complaints, habit of eye rubbing, best spectacle-corrected visual acuity (BSCVA), retinoscopy reflex, detailed slit-lamp examination and tomographic findings, and presence of any ocular and systemic associations were documented for the included patients. Severity of KC was further graded into stages 0, 1, 2, 3, and 4 according to the ABCD grading system. RESULTS The most common visual complaint was blurred vision (82.64%), followed by itching (48.76%), tearing (43.80%), and photophobia (41.32%). A total of 44.62% of patients had the habit of eye rubbing and 4.54% had a family history of KC. Most common clinical signs were scissor reflex (94.21%), Rizutti's sign (77.27%), corneal protrusion (69.83%), and Fleischer ring (67.35%). A total of 14.05% of patients had stage 0, 42.15% had stage 1, 19.83% had stage 2, 18.60% had stage 3, and 5.37% had stage 4 KC. Of these patients, 70.25% had a BSCVA visual acuity of ≥6/12 or better; 26.45% had a BSCVA of ≥6/60 to <6/12; and 3.30% had a BSCVA of <6/60. Ocular allergies, atopy, and asthma were found in 32.32%, 4.96%, and 2.48% cases, respectively. CONCLUSION This study gives an overview of the clinical findings of KC cases in western India. Our results suggest that use of retinoscopy should be promoted in early KC detection in primary eyecare screening programs.
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Affiliation(s)
- Zalak Shah
- Department of Cornea and Refractive Surgery, Shree C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
| | - Dipali Purohit
- Department of Cornea and Refractive Surgery, Shree C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
| | - Parul Danayak
- Department of Cornea and Refractive Surgery, Shree C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
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Belda-Para C, Velarde-Rodríguez G, Velasco-Ocaña M, Trujillo-Sevilla JM, Rodríguez-Méndez I, Rodríguez-Martin J, Alejandre-Alba N, Rodríguez-García S, Rodríguez-Ramos JM. Comparing the clinical applicability of wavefront phase imaging in keratoconus versus normal eyes. Sci Rep 2024; 14:9984. [PMID: 38693352 PMCID: PMC11063207 DOI: 10.1038/s41598-024-60842-9] [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: 12/07/2023] [Accepted: 04/28/2024] [Indexed: 05/03/2024] Open
Abstract
The aim of this work is to quantitatively assess the wavefront phase of keratoconic eyes measured by the ocular aberrometer t·eyede (based on WaveFront Phase Imaging Sensor), characterized by a lateral resolution of 8.6 µm without requiring any optical element to sample the wavefront information. We evaluated the parameters: root mean square error, Peak-to-Valley, and amplitude of the predominant frequency (Fourier Transform analysis) of a section of the High-Pass filter map in keratoconic and healthy cohorts. Furthermore, we have analyzed keratoconic eyes that presented dark-light bands in this map to assess their period and orientation with the Fourier Transform. There are significant statistical differences (p value < 0.001) between healthy and keratoconic eyes in the three parameters, demonstrating a tendency to increase with the severity of the disease. Otherwise, the quantification of the bands reveals that the width is independent of eye laterality and keratoconic stage as orientation, which tends to be oblique. In conclusion, the quantitative results obtained with t·eyede could help to diagnose and monitor the progression of keratoconus.
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Affiliation(s)
- Carolina Belda-Para
- Wooptix S.L., Avenida Trinidad, 61 Planta 7, 38000, La Laguna, Tenerife, Canary Islands, Spain.
- University of La Laguna, Calle Padre Herrera s/n, 38200, La Laguna, Tenerife, Canary Islands, Spain.
| | - Gonzalo Velarde-Rodríguez
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Avenida. Reyes Católicos 2, 28040, Madrid, Spain
| | - Miriam Velasco-Ocaña
- Wooptix S.L., Avenida Trinidad, 61 Planta 7, 38000, La Laguna, Tenerife, Canary Islands, Spain
| | - Juan M Trujillo-Sevilla
- Wooptix S.L., Avenida Trinidad, 61 Planta 7, 38000, La Laguna, Tenerife, Canary Islands, Spain
| | - Iván Rodríguez-Méndez
- Wooptix S.L., Avenida Trinidad, 61 Planta 7, 38000, La Laguna, Tenerife, Canary Islands, Spain
- University of La Laguna, Calle Padre Herrera s/n, 38200, La Laguna, Tenerife, Canary Islands, Spain
| | | | - Nicolas Alejandre-Alba
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Avenida. Reyes Católicos 2, 28040, Madrid, Spain
| | - Silvia Rodríguez-García
- University of La Laguna, Calle Padre Herrera s/n, 38200, La Laguna, Tenerife, Canary Islands, Spain
| | - José M Rodríguez-Ramos
- Wooptix S.L., Avenida Trinidad, 61 Planta 7, 38000, La Laguna, Tenerife, Canary Islands, Spain
- University of La Laguna, Calle Padre Herrera s/n, 38200, La Laguna, Tenerife, Canary Islands, Spain
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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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Chauhan P, Kamalakannan P, Upadhyay AD, Sinha R, Titiyal JS, Sharma N. Comparative Evaluation of Topographic Parameters Using Three Different Topographers in Keratoconic and Cross-linked Keratoconic Corneas. J Refract Surg 2024; 40:e260-e269. [PMID: 38593263 DOI: 10.3928/1081597x-20240311-07] [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: 04/11/2024]
Abstract
PURPOSE To compare the parameters of three different topographic devices (Pentacam HR, Oculus Optikgeräte GmbH; Sirius, Costruzione Strumenti Oftalmici; and Cassini, i-Optics) in grading the severity of keratoconus in cross-linked and non-cross-linked eyes. METHODS This was a prospective comparative interventional study done in a tertiary eye care center, wherein 114 eyes of 68 patients with keratoconus were divided into two groups: 62 eyes that were observed and 52 eyes that were cross-linked. All eyes were evaluated on all three topographers at baseline, 3-month follow-up, and 6-month follow-up. RESULTS The Sirius showed significantly lower values of mean flat keratometry in comparison to the Pentacam HR (limits of agreement [LoA]: 1.75 to 3.51%) and Cassini (LoA: 1.75 to 3.51%). The mean steep keratometry values were higher for the Cassini in comparison to the Pentacam HR (LoA: 4.39 to 7.02%) and Sirius (LoA: 3.51 to 6.14%). The mean steep keratometry values of the Sirius were significantly lower than those of the Pentacam HR and in both the cross-linked and observation groups (LoA: 3.51 to 6.14%). The mean keratometry values were significantly higher in the Cassini compared to the Pentacam HR (LoA: 3.51 to 8.77%) and significantly lower in the Sirius in comparison to the Pentacam HR (LoA: 3.51 to 6.14%). The mean difference in astigmatism was also statistically significant between the three tomographers in both groups, with the Cassini showing higher values (LoA: 3.51 to 5.26%) and the Sirius lower values than the Pentacam HR (LoA: 5.26 to 6.14%). CONCLUSIONS The authors conclude the three devices cannot be used interchangeably. The Cassini showed better agreement and correlation with the Pentacam HR in the staging of keratoconus, whereas the Sirius tended to underdiagnose and under-stage the disease. [J Refract Surg. 2024;40(4):e260-e269.].
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Bui AD, Truong A, Pasricha ND, Indaram M. Keratoconus Diagnosis and Treatment: Recent Advances and Future Directions. Clin Ophthalmol 2023; 17:2705-2718. [PMID: 37736107 PMCID: PMC10511017 DOI: 10.2147/opth.s392665] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Keratoconus is a disorder characterized by progressive corneal thinning and steepening that may result in significant visual impairment secondary to high astigmatism, corneal scarring, or even corneal perforation. Early detection and screening of keratoconus are essential for effective management and treatment. Several screening methods, such as corneal topography and tomography, corneal biomechanics, and genetic testing, are being developed to detect keratoconus at an early stage. Once detected, prevention of progression is the mainstay of keratoconus management. Corneal collagen cross-linking is a minimally invasive treatment option that can slow or halt the progression of keratoconus. Additionally, recent studies have investigated the potential use of copper sulfate eye drops (IVMED-80) and extracellular vesicles to prevent the progression of keratoconus as non-invasive treatment options. For visual rehabilitation, currently available treatments include scleral lenses, intracorneal ring segments, corneal allogenic intrastromal ring segments, and deep anterior lamellar keratoplasty. The safety and efficacy of these emerging treatment options for keratoconus are currently being investigated.
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Affiliation(s)
- Anh D Bui
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Angeline Truong
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neel D Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
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Velarde-Rodriguez G, Belda-Para C, Velasco-Ocaña M, Trujillo-Sevilla JM, Rodríguez-Martin J, Jiménez-Alfaro I, Rodriguez-Ramos JM, Alejandre-Alba N. Ultra-High Resolution Optical Aberrometry in Patients with Keratoconus: A Cross-Sectional Study. Ophthalmol Ther 2023; 12:1569-1582. [PMID: 36856979 PMCID: PMC10164210 DOI: 10.1007/s40123-023-00684-2] [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: 12/23/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION This study performs optical aberration assessment in patients using a novel ultra-high-resolution device. The objective of this study is to analyze optical aberrations, especially the very high order wavefront (more than 10th order of Zernike coefficients), and compare between keratoconus and healthy patients. METHODS In this cross-sectional study, we analyzed 43 eyes from 25 healthy patients and 43 eyes from 27 patients with keratoconus using corneal tomography and a very high-resolution (8.55 µm) aberrometer prototype (T-eyede) outfitted with a sensor originally developed for use in the field of astrophysics. Corneal aberration values were assessed using an optical model built with Zemax optical software, while ocular aberrations were assessed using T-eyede. In addition, image-processing analysis was performed of the wavefront phase, creating a high-pass filter map. RESULTS We found lower values for ocular aberrations than corneal aberrations in both groups (p < 0.001). Specifically, we found a reduction in primary astigmatism (0.145 µm) and primary coma (0.017 µm). Also, the keratoconus group showed significantly higher wavefront aberration values compared with controls (p < 0.001). An analysis of the high-pass filter map revealed 2 contrasting results: one smooth or clear, while the other presented a banding pattern. Almost all in the control group (95%) showed the first pattern, while 77% of the keratoconus group showed a banding pattern on the filtered map (chi-squared test, p < 0.001). CONCLUSION This device provides reliable, precise measurements of ocular aberrations that correlate well with corneal aberrations. Furthermore, the extraordinary high-resolution measurements revealed unprecedented micro changes in the wavefront phase of patients with keratoconus that varied with disease stage. These findings could lead to new screening or follow-up methods.
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Affiliation(s)
| | - Carolina Belda-Para
- Wooptix S.L. Avda, Trinidad 61 Planta 7, La Laguna, Tenerife, Canary Islands, Spain
| | - Miriam Velasco-Ocaña
- Wooptix S.L. Avda, Trinidad 61 Planta 7, La Laguna, Tenerife, Canary Islands, Spain
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Kirgiz A, Tülü Aygün B, Aşik Nacaroğlu Ş, Tellioglu A, Yildirim Y, Kepez Yildiz B, Kandemir Beşek N, Demirok A. Changes in anterior chamber dimensions following small incision lenticule extraction (SMILE). Int Ophthalmol 2023; 43:305-312. [PMID: 35854064 DOI: 10.1007/s10792-022-02429-9] [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: 03/14/2021] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the changes in anterior chamber dimensions including horizontal anterior chamber diameter (HACD), anterior chamber depth (ACD), and iridocorneal angle (ICA) following small incision lenticule extraction (SMILE) using Scheimpflug-Placido disk tomographer (Sirius). METHODS The records of the 73 eyes of 47 patients who received SMILE for myopia and myopic astigmatism were retrospectively reviewed. Preoperative and 6-month postoperative measurements of central corneal thickness (CCT), HACD, ACD, ICA, nasal anterior chamber angle (nACA), and temporal anterior chamber angle (tACA) were obtained by tomography, and compared with paired t-tests. Pearson's correlation and linear regression tests were used to evaluate the relationship between these parameters. RESULTS The CCT, HACD, and ACD values decreased significantly at 6-month postoperatively (p < 0.05 for all). ICA, nACA, and tACA showed no statistically significant difference postoperatively (p = 0.54, p = 0.118, and p = 0.255, respectively). Pearson's correlation analysis confirms negative relationship between Δ-HACD and Δ-tACA (r = -0.475, p < 0.01), and a loose negative relationship between change in ACD and change in ICA (r = -0.282, p = 0.016). Age and Δ-tACA were found as predictive parameters for Δ-HACD and, Δ-ICA was a predictor for Δ-ACD. CONCLUSION While HACD and ACD decreased significantly, there was no significant change in ICA, nACA and tACA. Changes in HACD and ACD should be considered in terms of subsequent surgeries after SMILE.
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Affiliation(s)
- Ahmet Kirgiz
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
| | - Beril Tülü Aygün
- Augenklinik Rendsburg, Provianthausstrasse 9, 24768, Rendsburg, Germany.
| | | | - Adem Tellioglu
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
| | - Yusuf Yildirim
- Department of Ophthalmology, University of Health Sciences Başakşehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Burçin Kepez Yildiz
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
| | - Nilay Kandemir Beşek
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
| | - Ahmet Demirok
- University of Health Sciences Beyoğlu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
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Li J, Xue C, Zhang Y, Liu C, Du J, Li Y, Liu J, Wei S, Wu Z. Diagnostic value of corneal higher-order aberrations in keratoconic eyes. Int Ophthalmol 2022; 43:1195-1206. [PMID: 36149622 DOI: 10.1007/s10792-022-02518-9] [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: 07/31/2022] [Accepted: 09/11/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to investigate the diagnostic value of corneal anterior, posterior, and total higher-order aberrations in keratoconic eyes. METHODS We enrolled 94 patients (152 eyes) with mild keratoconus (Group 1), 64 patients (101 eyes) with moderate keratoconus (Group 2), and 32 patients (52 eyes) with advanced keratoconus (Group 3) according to the Amsler-Krumeich classification system; 99 healthy controls (197 normal eyes) were likewise enrolled. Anterior, posterior, and total corneal higher-order aberrations were assessed using a rotating Scheimpflug camera. The 3rd-order and 4th-order root-mean-square values were calculated for higher-order aberrations, including coma, spherical, and trefoil aberrations. Differences between keratoconic and normal eyes were analyzed using Kruskal-Wallis tests. Receiver operating characteristic curves were evaluated for the keratoconus and control groups. RESULTS The differences in coma 90, coma, trefoil, and spherical aberrations, as well as 3rd-order and 4th-order root-mean-square values, were statistically significant between the keratoconus and control groups for all anterior, posterior, and corneal aberrations. The absolute values of these higher-order aberrations were higher in the keratoconus groups than in the control group and increased with keratoconus severity in Groups 1-3. Coma and 3rd-order RMS values showed excellent sensitivity and specificity for discriminating between normal and keratoconus eyes for all anterior, posterior, and corneal aberrations. CONCLUSION Coma aberrations and 3rd-order root-mean-square values may be valuable for diagnosing keratoconus. Combining these data with topography information may enable the effective and efficient detection of keratoconus in the future.
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Affiliation(s)
- Jing Li
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Chao Xue
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin, China
- Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China
| | - Yaohua Zhang
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Chunlei Liu
- Refractive Surgery Department, Shenyang Aier Eye Hospital, Shenyang, 110001, China
| | - Jing Du
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yong Li
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Jianguo Liu
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Shengsheng Wei
- Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China.
| | - Zhiqing Wu
- Department of Ophthalmology, Hospital of Shaanxi Normal University, Xi'an, China
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Harbiyeli II, Gul Olke K, Erdem E, Yagmur M. Correction of moderate to high refractive astigmatism with extended range toric soft contact lenses in patients with different patterns of astigmatism. Ophthalmic Physiol Opt 2022; 42:807-813. [PMID: 35333414 DOI: 10.1111/opo.12980] [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: 08/20/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to evaluate the visual performance of extended range, toric soft contact lenses (TSCLs) in patients with keratoconus and moderate to high astigmatism with different astigmatic patterns. METHODS This was a retrospective, cross-sectional clinical study. Extended range TSCL users with astigmatism ≥3.0 D were included. Cases were categorised into three subgroups, namely regular, irregular (non-keratoconus) and keratoconic based on the topographic pattern of astigmatism. In addition, subjects were subdivided based on the degree of astigmatism. RESULTS Fifty five patients (82 eyes) were enrolled, of whom 28 (51%) were female. The mean age was 24.2 ± 7.5 (range: 8-41 years) years. Thirty-six eyes with regular astigmatism (43.9%), 34 eyes with irregular astigmatism (41.5%) and 12 eyes with keratoconus (14.6%) were included. The percentage improvement in visual acuity (VA) was significantly higher with contact lenses compared with spectacles in all groups (p < 0.001), with the highest improvement in subjects with keratoconus (p = 0.03). Twenty six (31.7%), 30 (36.6%) and 26 eyes (31.7%) had moderate (-3.0 to -4.24 D), moderate/high (-4.25 to -5.99 D) and high (≤-6.0 D) astigmatism, respectively. The percentage improvement in VA with contact lenses was statistically significantly higher than for spectacle wear in all groups (p < 0.001). CONCLUSIONS This study demonstrated that satisfactory visual outcomes can be obtained with extended range TSCLs in patients having moderate to high astigmatism with different astigmatic patterns.
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Affiliation(s)
| | - Kubra Gul Olke
- Department of Ophthalmology, Seyhan State Hospital, Adana, Turkey
| | - Elif Erdem
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Meltem Yagmur
- Department of Ophthalmology, Faculty of Medicine, Cukurova University, Adana, Turkey
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Salman A, Darwish T, Ali A, Ghabra M, Rafea Shaaban. Sensitivity and specificity of Sirius indices in diagnosis of keratoconus and suspect keratoconus. Eur J Ophthalmol 2021; 32:11206721211060139. [PMID: 34812066 DOI: 10.1177/11206721211060139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To estimate the sensitivity and specificity of topographic and tomographic corneal parameters as determined by Sirius (CSO, Florence, Italy) in discriminating keratoconus (KC) and suspect keratoconus from normal cornea. METHOD In this retrospective case-series study, keratoconus screening indices were measured using Sirius tomographer. Receiver operating characteristics (ROC) curves were used to determine the test's overall predictive accuracy (area under the curve) and to identify optimal cut-off points to maximize sensitivity and specificity in differentiating keratoconus and suspect keratoconus from normal corneas. RESULTS Receiver operating characteristics (ROC) curve analyses showed high predictive accuracy for Symmetry Index back (SIb), Keratoconus Vertex front (KVf), Symmetry Index front (SIf), Keratoconus Vertex back (KVb), Apex Keratometry (Curve-Apex) and Minimum corneal Thickness (ThkMin) to distinguish keratoconus from normal (area under the curve > 0.9, all). Symmetry Index back was identified as the best diagnostic parameter for detecting suspect keratoconus with AUC of 0.86. Highest specificity to detect keratoconus and suspect keratoconus was seen for SIb, 99.87% and 84.66%, respectively. These values were associated with optimal cut-off points of 0.46 D for keratoconus and 0.12 D for suspect keratoconus. CONCLUSION Sirius parameters evaluated in the study were effective to differentiate keratoconus from normal corneas. However, Symmetry Index back was the index with the highest ability to detect suspect keratoconus.
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Affiliation(s)
| | - Taym Darwish
- Department of Ophthalmology, Tishreen University, Lattakia, Syrian Arab Republic
| | - Ali Ali
- Department of Ophthalmology, 37585Tishreen University, Lattakia, Syrian Arab Republic
| | | | - Rafea Shaaban
- 536622Tartous University, Tartous, Syrian Arab Republic
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