Corneal Elevation Indices in Normal and Keratoconic Eyes

Purpose: To determine an index that distinguishes keratoconus and keratoconus-suspect eyes from normal eyes with Orbscan (Bausch & Lomb) corneal elevation maps.

Setting: Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, and iLaser Centre, Island Hospital, Penang, Malaysia.

Methods: In this initial phase of this multicenter nonrandomized retrospective study, 1 eye of 166 normal subjects, 15 keratoconus patients, and 11 keratoconus suspects was examined at 1 clinic. The anterior best-fit sphere (BFS), posterior BFS, anterior elevation, posterior elevation, and maximum and minimum keratometries were analyzed. Two indices with the highest sensitivity and specificity classifying these conditions were identified using receiver operating characteristic curves. These 2 indices were evaluated in a subsequent validation study using 1 eye of 221 normal subjects, 43 keratoconus patients, and 23 keratoconus suspects from another clinic.

Results: The anterior elevation and anterior elevation ratio (anterior elevation ratio = anterior elevation/anterior BFS) best classified the different groups. An anterior elevation ratio of 0.5122 mm or less had 99% sensitivity and 95.2% specificity while a ratio 16.5 mum or less had 80.1% sensitivity and 80.8% specificity in discriminating normal eyes from keratoconus and keratoconus suspects. The results were similar in the validation study. In addition, these anterior elevation and anterior elevation ratio cutoff values had high sensitivity and specificity in identifying keratoconus suspects from normal eyes in the validation study.

Conclusion: Anterior corneal elevation parameters are clinically relevant measures for detecting keratoconus and suspected keratoconus eyes.