Skip to main content
SpringerLink
Log in

Assessing Keratoconus Progression

  • Chapter
  • First Online:
Keratoconus

  • 538 Accesses

Abstract

A variety of methods have been described to both evaluate and document keratoconus progression. In a clinical practice, the ophthalmologist usually evaluates two scans of a patient performed a few months apart to estimate if there is a progression of the disease. Today, besides corneal keratometry, there are many other parameters that are also examined in order to evaluate if the keratoconus is progressing, including change in best-corrected distance visual acuity (CDVA) or uncorrected distance visual acuity (UDVA), manifest refraction, change on the posterior elevation maps, reduction in apical corneal thickness, increase in anterior corneal asymmetry, index of surface variance (ISV), the index of height decentration (IHD), and the maximum anterior saggital curvature (Kmax).

In this chapter, we describe in more detail the possible options of markers or indices that can be used to identify keratoconus progression. We also present the reasons why Belin ABCD progression display can be a good option for the diagnosis of keratoconus change. The advantage of using such a wide number of indexes is to provide reproducible and comparable measurements at different time intervals. We support what many authors have just recently published regarding performing more than one imaging at a time to create reliable results (minimal 3 images, ideally 5 images) and recommend evaluating at least two parameters. Only a deep knowledge of the meaning of all these indexes and values increases reliability in the evaluation of keratoconus progression. Further prospective studies are needed to confirm the importance, applicability, and consistency of each index.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Gomes JAP, Tan D, Rapuano CJ, Belin MW, Ambrósio R Jr, Guell JL, et al. Global consensus on keratoconus and ectatic disease. Cornea. 2015;34(4):359–69.

    Article  PubMed  Google Scholar 

  2. Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998;42(4):297–319.

    Article  CAS  PubMed  Google Scholar 

  3. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of corneal collagen cross-linking in children and adolescents. J Refract Surg. 2012;28(11):753–8.

    Article  PubMed  Google Scholar 

  4. Léoni-Mesplié S, Mortemousque B, Touboul D, Malet F, Praud D, Mesplié N, Colin J. Scalability and severity of keratoconus in children. Am J Ophthalmol. 2012;154(7):56–62.

    Article  PubMed  Google Scholar 

  5. Romano V, Vinciguerra R, Arbabi E, Hicks N, Rosetta P, Vinciguerra P, Kaye SB. J Refract Surg. 2018;34(3):177–80.

    Article  PubMed  Google Scholar 

  6. Ferdi AC, Nguyen V, Gore DM, Allan BD, Rozema JJ, Watson SL. Keratoconus natural progression. A systematic review and meta-analysis of 11,529 eyes. Ophthalmol. 2019;126(7):935–45.

    Article  Google Scholar 

  7. Barr JT, Wilson BS, Gordon MO, et al. Estimation of the incidence and factors predictive of corneal scarring in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. Cornea. 2006;25(1):16–25.

    Google Scholar 

  8. Reeves SW, Stinnett S, Adelman RA, Afshari NA. Risk factors for progression to penetrating keratoplasty in patients with keratoconus. Am J Ophthalmol. 2005;140(4):607–11.

    Article  PubMed  Google Scholar 

  9. Prakash G, Philip R, Srivastava D, Bacero R. Evaluation of the robustness of current quantitative criteria for keratoconus progression and corneal cross-linking. J Refract Surg. 2016;32(7):465–72.

    Article  PubMed  Google Scholar 

  10. Epstein RL, Chiu YL, Epstein GL. Pentacam HR criteria for curvature change in keratoconus and postoperative LASIK ectasia. J Refract Surg. 2012;28(12):890–4.

    Article  PubMed  Google Scholar 

  11. Li Y, Tan O, Brass R, Weiss JL, Huang D. Corneal epithelial thickness mapping by Fourier-domain optical coherence tomography in normal and keratoconic eyes. Ophthalmol. 2012;119(12):2425–33.

    Article  Google Scholar 

  12. Li Y, Chamberlain W, Tan O, Brass R, Weiss JL, Huang D. Subclinical keratoconus detection by pattern analysis of corneal and epithelial thickness maps with optical coherence tomography. J Cataract Refrac Surg. 2016;42(2):284–95.

    Article  Google Scholar 

  13. Kanellopoulos AJ, Aslanides IM, Asimellis G. Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor? Clin Ophthalmol. 2012;6(5):789–800.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Rocha KM, Perez-Straziota CE, Stulting RD, Randleman JB. SD-OCT analysis of regional epithelial thickness profiles in keratoconus, postoperative corneal ectasia, and normal eyes. J Refract Surg. 2013;29(3):173–9. errata, 234.

    Google Scholar 

  15. Ouanezar S, Sandali O, Atia R, Temstet C, Georgeon C, Laroche L, Borderie V, Bouheraoua N. Contribution of Fourier-domain optical coherence tomography to the diagnosis of keratoconus progression. J Cataract Refract Surg. 2019;45(2):159–66.

    Article  PubMed  Google Scholar 

  16. Choi JA, Kim MS. Progression of keratoconus by longitudinal assessment with corneal topography. Invest Ophthalmol Vis Sci. 2012;53(2):927–35.

    Article  PubMed  Google Scholar 

  17. Kanellopoulos AJ, Asimellis G. Revisiting keratoconus diagnosis and progression classification based on evaluating of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases. Clin Ophthalmol. 2013;7(7):1539–48.

    Article  PubMed  Google Scholar 

  18. Hersh PS, Stulting RD, Muller D, Durrie DS, Rajpal RK. United States multicenter clinical trial of corneal collagen crosslinking for keratoconus treatment. Ophthalmol. 2017;124(9):1259–70.

    Article  Google Scholar 

  19. Witting-Silva C, Chan E, Islam FMA, Wu T, Whiting M, Snibson GR. A randomized, controlled trial of corneal collagen cross-linking in progressive keratoconus. Ophthalmol. 2014;121(4):812–21.

    Article  Google Scholar 

  20. Chowdhury K, Dore C, Burr JM, Bunce C, Raynor M, Edwards M, Larkin DFP. A randomized, controlled, observer-masked trial of corneal cross-linking for progressive keratoconus in children: the KERALINK protocol. BMJ Open. 2019;9:e028761.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Toker E, Çerman E, Ozcan DO, Seferoglu OB. Efficacy of different accelerated corneal crosslinking protocols for progressive keratoconus. J Cataract Refract Surg. 2017;43(8):1089–99.

    Article  PubMed  Google Scholar 

  22. Mazzotta C, Baiocchi S, Bagaglia AS, Fruschelli M, Meduri A, Rechichi M. Accelerated 15 mW pulsed-light crosslinking to treat progressive keratoconus: two-year clinical results. J Cataract Refract Surg. 2017;43(8):1081–8.

    Google Scholar 

  23. Hashemian H, Jabbarvand M, Khodaparast M, Ameli K. Evaluation of corneal changes after conventional versus accelerated corneal cross-linking: a randomized controlled trial. J Refract Surg. 2014;30(12):837–42.

    Article  PubMed  Google Scholar 

  24. Aixinjueluo W, Usui T, Miyai T, Toyono T, Sakisaka T, Yamagami S. Accelerated transepithelial corneal cross-linking for progressive keratoconus; a prospective study of 12 months. Br J Ophthalmol. 2017;101(10):1244–9.

    Article  PubMed  Google Scholar 

  25. Santhiago MR. Corneal crosslinking: the standard protocol. Rev Bras Oftalmol. 2017;76(1):43–9.

    Article  Google Scholar 

  26. Shajari M, Steinwender G, Herrmann K, Kubiak KB, Pavlovic I, Plawetzki E, Schmack I, Kohnene T. Evaluation of keratoconus progression. Br J Ophthalmol. 2019;103(6):551–7.

    Article  PubMed  Google Scholar 

  27. Choi JA, Kim M-S. Progression of keratoconus by longitudinal assessment with corneal topography. Invest Ophthalmol Vis Sci. 2012;53(2):927–35. Available at: http://iovs.arvojournals.org/article.aspx?articleidZ2188463.

    Article  PubMed  Google Scholar 

  28. Duncan JK, Belin MW, Borgstrom M. Assessing progression of keratoconus: novel tomographic determinants. Eye Vis. 2016;3(3):1–9.

    Google Scholar 

  29. Muftuoglu O, Ayar O, Ozulken K, Ozyol E, Akinci A. Posterior corneal elevation and back difference corneal elevation in diagnosing forme fruste keratoconus in the fellow eyes of unilateral keratoconus patients. J Cataract Refract Surg. 2013;39(9):1348–57.

    Article  PubMed  Google Scholar 

  30. Demir S. SönmezB, Yeter V, Ortak H. comparison of normal and keratoconic corneas by Galilei dual-Scheimpflug analyzer. Cont Lens Anterior Eye. 2013;36(5):219–25.

    Article  PubMed  Google Scholar 

  31. Oshika T, Tanabe T, Tomidokoro A, Amano S. Progression of keratoconus assessed by Fourier analysis of videokeratography data. Ophthalmology. 2002;109(2):339–42.

    Article  PubMed  Google Scholar 

  32. Suzuki M, Amano S, Honda N, Usui T, Yamagami S, Oshika T. Longitudinal changes in corneal irregular astigmatism and visual acuity in eyes with keratoconus. Jpn J Ophthalmol. 2007;51(4):265–9.

    Article  PubMed  Google Scholar 

  33. Duncan J, Gomes JA. A new tomographic method of staging/classifying keratoconus: the ABCD grading system. Int J Keratoconus Ectatic Corneal Dis. 2015;4(3):85–93.

    Article  Google Scholar 

  34. Belin MW, Ambrósio R. Scheimpflug imaging for keratoconus and ectatic disease. Indian J Ophthalmol. 2013;61(8):401–6.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Belin MW, Duncan JK. Keratoconus: the ABCD grading system. Klin Monatsbl Augenheilkd. 2016;233(6):701–7.

    Article  CAS  PubMed  Google Scholar 

  36. Villavicencio OF, Gilani F, Henriquez MA, Izquierdo L, Ambrósio RR. Independent population validation of the Belin/Ambrósio enhanced ectasia display: implications for keratoconus studies and screening. Int J Keratoconus Ectatic Corneal Dis. 2014;3(1):1–8.

    Article  Google Scholar 

  37. Belin MW, Villavicencio OF, Ambrósio RR. Tomographic parameters for the detection of keratoconus: suggestions for screening and treatment parameters. Eye Contact Lens. 2014;40(6):326–30.

    Article  PubMed  Google Scholar 

  38. Orucoglu F, Toker E. Comparative analysis of anterior segment parameters in normal and keratoconus eyes generated by Scheimpflug tomography. J Ophthalmol. 2015;2015:925414. https://doi.org/10.1155/2015/925414.

  39. Belin MW, Meyer JJ, Duncan JK, Gelman R, Borgstrom M. Assessing progression of keratoconus and cross-linking efficacy: the Belin ABCD progression display. Int J Keratoconus Ectatic Corneal Dis. 2017;6(1):1–10.

    Article  Google Scholar 

  40. Sedaghat MR, Momeni-Moghaddam H, Belin MW, Zarei-Ghanavati S, Akbarzadeh R, Sabzi F, et al. Changes in the ABCD keratoconus grade after intracorneal ring segment implantation. Cornea. 2018;37(11):1431–7.

    Article  PubMed  Google Scholar 

  41. Kosekahya P, Caglayan M, Koc M, Kiziltoprak H, Tekin K, Atilgan CU. Longitudinal evaluation of the progression of keratoconus using a novel progression display. Eye Contact Lens. 2019;45(5):324–30.

    Article  PubMed  Google Scholar 

Download references

Funding/Support

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Financial Disclosures

None of the authors have any financial interest in any products or procedures mentioned in this chapter.

None of the authors have any conflict of interest related to any product or procedure mentioned in this chapter.

Author information

Authors and Affiliations

  1. Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil

    Patrick Frensel Tzelikis

  2. University of São Paulo (USP), São Paulo, SP, Brazil

    Patrick Frensel Tzelikis

  3. Corneal and External Eye Diseases Service, Wills Eye Hospital, Philadelphia, PA, USA

    Patrick Frensel Tzelikis

  4. Corneal and Refractive Surgery Department, Hospital Oftalmológico de Brasília (HOB), Brasília, DF, Brazil

    Ludmila Nascimento P. Silva & Guilherme Rocha

  5. Contact Lenses Department, Hospital Oftalmológico de Brasília (HOB), Brasília, DF, Brazil

    Guilherme Rocha

Authors
  1. Patrick Frensel Tzelikis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ludmila Nascimento P. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guilherme Rocha
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Provisão Eye Hospital of Maringá, Maringá, Paraná, Brazil

    Edna Almodin

  2. Federal University of São Paulo, São Paulo, São Paulo, Brazil

    Belquiz Amaral Nassaralla

  3. Nucleo de Medicina Ocular, Goiânia, Goiás, Brazil

    Jordana Sandes

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tzelikis, P.F., Silva, L.N.P., Rocha, G. (2022). Assessing Keratoconus Progression. In: Almodin, E., Nassaralla, B.A., Sandes, J. (eds) Keratoconus . Springer, Cham. https://doi.org/10.1007/978-3-030-85361-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-85361-7_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-85360-0

  • Online ISBN: 978-3-030-85361-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation