Early stages of keratoconus are hard to diagnose and best results can be achieved by using index of height decentration and index of vertical asymmetry. As the disease progresses, D-index is better suited to diagnose an ectasia. Astigmatism, keratometry, and pachymetry barely change in the early stages, so these values are not as fitting as corneal elevation parameters for early diagnosis. [J Refract Surg. 2018;34(4):254-259.].
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