Enhanced Diagnostics for Corneal Ectatic Diseases: The Whats, the Whys, and the Hows

Abstract

There are different fundamental diagnostic strategies for patients with ectatic corneal diseases (ECDs): screening, confirmation of the diagnosis, classification of the type of ECD, severity staging, prognostic assessment, and clinical follow-up. The conscious application of such strategies enables individualized treatments. The need for improved diagnostics of ECD is related to the advent of therapeutic refractive procedures that are considered prior to keratoplasty. Among such less invasive procedures, we include corneal crosslinking, customized ablations, and intracorneal ring segment implantation. Besides the paradigm shift in managing patients with ECD, enhancing the sensitivity to detect very mild forms of disease, and characterizing the inherent susceptibility for ectasia progression, became relevant for identifying patients at higher risk for progressive iatrogenic ectasia after laser vision correction (LVC). Moreover, the hypothesis that mild keratoconus is a risk factor for delivering a baby with Down’s syndrome potentially augments the relevance of the diagnostics of ECD. Multimodal refractive imaging involves different technologies, including Placido-disk corneal topography, Scheimpflug 3-D tomography, segmental or layered tomography with layered epithelial thickness using OCT (optical coherence tomography), and digital very high-frequency ultrasound (VHF-US), and ocular wavefront. Corneal biomechanical assessments and genetic and molecular biology tests have translated to clinical measurements. Artificial intelligence allows for the integration of a plethora of clinical data and has proven its relevance in facilitating clinical decisions, allowing personalized or individualized treatments.

Keratoconus: imaging modalities and management

“…New corneal tomographic imaging technologies have enhanced the diagnostic capabilities of topography by providing 3-dimensional representations of the entire cornea using techniques such as slit-scanning, Scheimpflug photography, and optical coherence tomography (OCT) [ 23 ] . Unlike traditional topography, which analyzes only the front corneal surface curvatures based on optical reflections, these tomographic methods allow for assessments of both the front and back corneal surface elevations and the corneal thickness profile [ 24 ] .…”

Advanced Surface Ablation in a Patient With Suspect Topography: A Case Report

“…More importantly, one must remember to perform additional characterization of the tomographic and biomechanical properties of the patient’s eyes. The tomographic and biomechanical properties of the cornea are of paramount importance to the final therapeutic decision [ 25 , 26 ]. These diagnostic strategies improve the ability to detect early forms of disease (KC) and allow the identification of patients with a more significant risk for ectasia progression after LVC [ 26 ].…”

“…The tomographic and biomechanical properties of the cornea are of paramount importance to the final therapeutic decision [ 25 , 26 ]. These diagnostic strategies improve the ability to detect early forms of disease (KC) and allow the identification of patients with a more significant risk for ectasia progression after LVC [ 26 ]. Therefore, current multimodal refractive imaging should involve multiple different technologies [ 27 ].…”

Keratoconus and Corneal Ectasia with Relatively Low Keratometry

“…Deciding whether to perform a procedure and determining the most suitable method for each patient requires personalized consideration. Additionally, patient compliance must include advice to avoid eye rubbing, treat ocular allergies, and optimize the ocular surface [ 45 ].…”