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Bajtl D, Bjeloš M, Bušić M, Ćurić A, Biuk D, Barać J. Corneal Fourier and Belin-Ambrósio Enhanced Ectasia Analysis in Healthy 4-Year-Old White Children. Cornea 2024; 43:59-62. [PMID: 36728315 DOI: 10.1097/ico.0000000000003236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to provide normative databases of Fourier analysis (FA) and Belin-Ambrósio enhanced ectasia display (BAD) in healthy White 4-year-old emmetropic children. METHODS FA parameters analyzed were spherical component (SRmin), spherical eccentricity (SEcc), maximal decentration (MD), regular astigmatism at the center (Astigm. C) and periphery (Astigm. P), and irregularity (I). The parameters obtained by BAD included summary indicator BAD D, anterior corneal curvature (K1 and K2, D), maximal keratometry (Kmax, D), maximal Ambrósio relational thinnest (ART max), and pachymetric and BAD indices. RESULTS Eighty-nine eyes of eighty-nine 4-year-old children were included. The mean values of FA parameters were the following: SRmin 7.77, SEcc 0.600, MD 0.160, Astigm. C 0.070, Astigm. P 0.050, and I 0.019. The mean K1 and K2 in our study group were 42.92 ± 1.29 D and 43.75 ± 1.41 D, with the mean BAD D value 0.42 ± 0.67. The mean PPI min 0.629 ± 0.117, PPI max 1.059 ± 0.155, PPI avg 0.847 ± 0.103, Kmax 44.10 ± 1.39, and median of ART max 515.0 were recorded. No statistically significant differences between male and female sex in any of FA or BAD parameters were found. CONCLUSIONS This is the first study providing large normative data on FA and BAD in 4-year-old White emmetropic children. We proposed a cutoff D value for early ectasia and clinical keratoconus in 4-year-old children.
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Affiliation(s)
- Dunja Bajtl
- University Eye Department, University Hospital Centre Osijek
| | - Mirjana Bjeloš
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, Reference Centre of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies University Hospital "Sveti Duh", Zagreb ; and
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Mladen Bušić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, Reference Centre of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies University Hospital "Sveti Duh", Zagreb ; and
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Ana Ćurić
- University Eye Department, Reference Centre of the Ministry of Health of the Republic of Croatia for Paediatric Ophthalmology and Strabismus, Reference Centre of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies University Hospital "Sveti Duh", Zagreb ; and
- Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Croatia
| | - Dubravka Biuk
- University Eye Department, University Hospital Centre Osijek
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek
| | - Josip Barać
- University Eye Department, University Hospital Centre Osijek
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek
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Price LD, Larkin DFP. Diagnosis and management of keratoconus in the paediatric age group: a review of current evidence. Eye (Lond) 2023; 37:3718-3724. [PMID: 37280353 PMCID: PMC10698037 DOI: 10.1038/s41433-023-02600-1] [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: 10/18/2022] [Revised: 04/12/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023] Open
Abstract
The diagnosis and management of keratoconus in the paediatric age group presents additional challenges to those encountered in adults. The most significant of these, encountered in some young patients, are delayed presentation of unilateral disease, more advanced disease at diagnosis, difficulty in obtaining reliable corneal imaging, faster rates of disease progression and challenges in contact lens management. The stabilisation effect of corneal cross-linking (CXL), more extensively studied in adults with randomised trials and long-term follow-up, has been much less rigorously examined in children and adolescents. The high heterogeneity of published studies in younger patients, particularly in the choice of tomography parameters designated as primary outcome measures and the definitions of progression, indicates that improved standardisation for future studies on CXL will be necessary. There is no evidence that corneal transplant outcomes in young patients are poorer than those in adults. This review provides a current perspective on the optimal diagnosis and treatment of keratoconus in children and adolescents.
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Affiliation(s)
- Liam D Price
- Moorfields Eye Hospital, London, United Kingdom.
| | - Daniel F P Larkin
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
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Abdul Fattah M, Mireskandari K, Fung SSM, Woo JH, Ali A. Children with high astigmatism: tomographic and refractive characteristics and the ability of current indices to rule out keratoconus. J AAPOS 2023; 27:328.e1-328.e7. [PMID: 39195354 DOI: 10.1016/j.jaapos.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/19/2023] [Indexed: 08/29/2024]
Abstract
PURPOSE To assess corneal tomographic, topographic, and refractive changes in children with high astigmatism and their ability to exclude keratoconus. METHODS In this longitudinal observational study, the medical records of children with high regular cylindrical refraction of ≥3.50 D referred to the Hospital for Sick Children, Toronto, to exclude keratoconus between January 2009 and June 2020 were reviewed retrospectively. Corneal tomography records (Scheimpflug imaging) were reviewed for subjects with total astigmatism of ≥ +3.50 D by retinoscopy. Children with abnormal anterior segment examination and/or other risk factors for corneal disease or ectasia and those with unreliable corneal tomography were excluded. Baseline demographic, longitudinal tomographic, topographic, and refractive data were analyzed. RESULTS A total of 67 eyes of 37 children (mean age, 9.1 ± 3.5 years) were included. Mean cylindrical refraction at presentation was 5.10 ± 1.30 D. Mean follow-up was 2.3 ± 1.8 years. Twenty-nine eyes had Kmax ≥47.20 D at baseline, with no change at last follow-up. Ksteep, Kmax, and thinnest pachymetry were 46.44 ± 2.33 D, 47.06 ± 2.57 D, and 525.86 ± 35.45 μm, respectively, at baseline compared with 46.40 ± 2.28 D, 46.98 ± 2.40 D, and 527.61 ± 37.67 μm at last follow-up (P > 0.05). All eyes were predicted as not having keratoconus using inferior-superior dioptric asymmetry ratio (I-S ratio), and the keratometry, inferior-superior, and astigmatism index (KISA%), which also incorporates skew percentage. The other tomographic indices predicted keratoconus or subclinical keratoconus in at least 22.4% of eyes. All parameters did not significantly change during follow-up. CONCLUSIONS In the absence of other risk factors for keratoconus, children with high regular astigmatism demonstrated clinical and tomographic stability over time. Based on our results, we recommend that I-S ratio and KISA% be primarily used when monitoring normal children with high astigmatism to rule out keratoconus-related changes.
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Affiliation(s)
- Maamoun Abdul Fattah
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Simon S M Fung
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, California
| | - Jyh Haur Woo
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Singapore National Eye Centre, Singapore
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
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Chen X, Huang Y, Chen H, Liu L. Distribution and Characteristics of Ocular Biometric Parameters among a Chinese Population: A Hospital-Based Study. Ophthalmol Ther 2023; 12:2117-2131. [PMID: 37233976 PMCID: PMC10287596 DOI: 10.1007/s40123-023-00716-x] [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: 12/31/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION This study aimed to describe the distribution and characteristics of ocular biometric parameters among a large Chinese population. METHODS This retrospective cross-sectional study included 146,748 subjects whose ocular biometric parameters were measured at the ophthalmology clinic of West China Hospital, Sichuan University, and recorded in the hospital database. Ocular biometric parameters, including axial length, anterior chamber depth, corneal keratometry, and keratometric astigmatism, were recorded. Only monocular data for each subject were analyzed to avoid bias. RESULTS Valid data from 85,770 subjects (43,552 females and 42,218 males) aged 3-114 years were included in this study. The mean axial length, mean anterior chamber depth, average corneal keratometry, and mean keratometric astigmatism were 24.61 mm, 3.30 mm, 43.76 D, and 1.19 D, respectively. The stratification of the ocular parameters by age and gender showed significant inter-gender and inter-age differences. CONCLUSIONS Analysis of a large population of subjects in western China aged 3-114 years showed that the distribution and characteristics of ocular biometric parameters, including axial length, anterior chamber depth, corneal keratometry, and keratometric astigmatism, differed by age and gender. This study is the first to describe ocular biometric parameters in subjects aged > 100 years.
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Affiliation(s)
- Xiaohang Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, People's Republic of China
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yongzhi Huang
- Department of Ophthalmology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hao Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 610041, Sichuan, People's Republic of China.
- Laboratory of Optometry and Vision Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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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.
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Diagnostic accuracy of different keratoconus detection indices of pentacam in paediatric eyes. Eye (Lond) 2022; 37:1130-1138. [PMID: 35505110 PMCID: PMC10102329 DOI: 10.1038/s41433-022-02070-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE No diagnostic gold standard for keratoconus in children and adolescents exists. Our objective was investigating the diagnostic accuracy of various indices for keratoconus (KC) detection in paediatric eyes. METHODS All retrievable data of significance from 432 normal right paediatric eyes and 48 eyes of paediatric KC and forme fruste KC (FFKC), imaged by use of a rotating Scheimpflug camera (Oculyzer II, Pentacam HR) between December 2013 and October 2018 at Watany Eye Hospitals, Cairo, Egypt, including Scheimpflug images data, were collected. The area under the receiver operating characteristic curve (AUROC) was calculated for different indices in this retrospective descriptive study. RESULTS All 36 tested indices showed discriminative power differentiating KC and FFKC from normal corneas (AUROC P-value <0.05), except AC volume, AC angle, and horizontal decentrations of the steepest and thinnest points. The 32 indices showed variable degrees of diagnostic accuracy. The highest AUROC was that of the corneal assessment index from the relational thickness and other OCULUS values (CAIRO 8). Only 8 indices showed non-inferiority to it, namely, Ambrosio's relational thickness maximum (ART max) and avg, the pachymetric progression index maximum (PPI max) and avg, the back elevation from the best-fit toric ellipsoid (BE BFTE), the KC index (KI), the topographic KC indices (TKC), and the index of height decentration (IHD) (P > 0.05). CONCLUSIONS The 8 most useful rotating Scheimpflug imaging indices for KC detection in paediatric eyes are CAIRO 8 followed by ART max and avg, PPI max and avg, BE BFTE, KI, TKC, and IHD.
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