Prospective Clinical Study of Keratoconus Progression in Patients Awaiting Corneal Cross-linking

Goh, Yi Wei; Gokul, Akilesh; Yadegarfar, Mohammad E; Vellara, Hans; Shew, William; Patel, Dipika V.; McGhee, Charles N J; Ziaei, Mohammed

doi:10.1097/ico.0000000000002376

Cited by 23 publications

(31 citation statements)

References 39 publications

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“…As expected, the percentage of triplets categorized as suspect progressive here (48%) is higher than the rates of clinically meaningful progression in recent studies [ 38 , 39 ]. We also note that had one-sided confidence intervals been used [ 7 ], 1.96 would have to be replaced by 1.64 in the formula, narrowing the 95 CI and increasing the percentage of suspect progressive cases.…”

Section: Discussionsupporting

confidence: 71%

Forecasting Progressive Trends in Keratoconus by Means of a Time Delay Neural Network

Jiménez‐García

Issarti

Kreps

et al. 2021

JCM

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Early and accurate detection of keratoconus progression is particularly important for the prudent, cost-effective use of corneal cross-linking and judicious timing of clinical follow-up visits. The aim of this study was to verify whether a progression could be predicted based on two prior tomography measurements and to verify the accuracy of the system when labelling the eye as stable or suspect progressive. Data from 743 patients measured by Pentacam (Oculus, Wetzlar, Germany) were available, and they were filtered and preprocessed to data quality needs. The time delay neural network received six features as input, measured in two consecutive examinations, predicted the future values, and determined the classification (stable or suspect progressive) based on the significance of the change from the baseline. The system showed a sensitivity of 70.8% and a specificity of 80.6%. On average, the positive and negative predictive values were 71.4% and 80.2%. Including data of less quality (as defined by the software) did not significantly worsen the results. This predictive system constitutes another step towards a personalized management of keratoconus. While the results obtained were modest and perhaps insufficient to decide on a surgical procedure, such as cross-linking, they may be useful to customize the timing for the patient’s next follow-up.

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Section: Discussionsupporting

confidence: 71%

Forecasting Progressive Trends in Keratoconus by Means of a Time Delay Neural Network

Jiménez‐García

Issarti

Kreps

et al. 2021

JCM

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“…The ability of OCT to diagnose early keratoconus otherwise not detectable on clinical and tomographic evaluation may assist in expediting early treatment and preventing disease progression [20]. This can potentially mitigate delays that can occur due to the high need for CXL in certain populations [5]. Epithelial changes on OCT are thought to be the first detectable sign of ectasia, representing an initial epithelial compensation in response to underlying stromal changes [10].…”

Section: Discussionmentioning

confidence: 99%

“…Corneal topography has long been the mainstay of diagnosis, staging, and progression analysis in this clinical entity, but in recent years, epithelial thickness (ET) maps have played an increasingly more prominent role in the early detection of subclinical cases [2]. Previous studies have shown that early detection of keratoconus with timely cornea crosslinking (CXL) can halt the progression of the disease, maintain or improve visual acuity and lead to a reduction in the number of patients requiring keratoplasty [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Repeatability of corneal and epithelial thickness measurements with anterior segment optical coherence tomography in keratoconus

Gokul

McGhee

et al. 2021

PLoS ONE

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Purpose To investigate the repeatability in corneal thickness (CT) and epithelial thickness (ET) measurements using spectral domain anterior segment optical coherence tomography (AS-OCT, REVO NX, Optopol) in keratoconus, and examine the effect of corneal crosslinking (CXL) on repeatability. Methods A cross-sectional study of 259 eyes of 212 patients with keratoconus attending the corneal disease clinic at a university hospital tertiary referral center were enrolled. Two groups were analysed: eyes with no prior history of CXL (Group A) and eyes with prior CXL (Group B). Repeatability of measurements was assessed using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). Results In Group A, central corneal thickness (CCT) was 472.18 ± 45.41μm, and the ET was found to be the thinnest in the inferior-temporal aspect at 51.79 ± 5.97μm and thickest at the superior-nasal aspect at 56.07 ± 5.70μm. In Group B, CCT was 465.11± 42.28μm, and the ET was the thinnest at the inferior-temporal aspect at 50.63 ± 5.52μm and thickest at the superior aspect at 56.80 ± 6.39μm. When evaluating CT measurements, ICC was above 0.86 and 0.83 for Group A and Group B respectively. When evaluating ET measurements, ICC was above 0.82 for both groups. CXL had no statistically significant impact on the repeatability of measurements. Conclusions AS-OCT provides repeatable CT and ET measurements in the central and peripheral cornea in patients with keratoconus. Repeatability is not affected by a history of CXL.

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“…This will help to identify at risk individuals/populations, optimize long-term management of the affected population, and provide appropriate access to modalities such as contact lenses (CLs), corneal crosslinking (CXL), and corneal transplantation. 22,23 Advances in rigid gas permeable (RGP) lens technologies have made it possible for most cases of keratoconus to be managed by community optometrists, thus an investigation focused on these cases would likely encompass a large proportion of the population with keratoconus. The Aotearoa Research into Keratoconus (ARK) study focused on subjects with keratoconus managed by optometrists in NZ.…”

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confidence: 99%

The Aotearoa Research Into Keratoconus Study: Geographic Distribution, Demographics, and Clinical Characteristics of Keratoconus in New Zealand

Gokul

Ziaei

Mathan

et al. 2021

Cornea

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was completed for every patient with keratoconus who underwent a consultation with participating optometrists in a 2-year period. Data for each patient included date of birth, sex, self-reported ethnicity, new or previous diagnosis, uncorrected (UCVA) and best-corrected visual acuity (BCVA), type of refractive correction required to obtain BCVA and keratometric readings obtained using keratometry or computerized topography.Results: One thousand eight hundred sixty-nine cases were identified, with a mean age of 41.0 6 15.7 years, 56.4% being men, and 87.3% with previous diagnosis. The distribution of cases was skewed toward Auckland (41.6%), Waikato (21.3%), Wellington (16.8%), and Bay of Plenty (13.3%). Self-reported ethnicities were predominantly NZ European (54.4%), M aori (24.7%), and Pacific Peoples (15.5%), disproportionate to the general population profile (74.0%, 14.9%, and 7.4% respectively). Most eyes (64.3%) were managed with rigid contact lenses (corneal lens in 34.2%). The mean K-mean was 49.0 6 5.7 D. The mean UCVA was 6/42 and BCVA was 6/9. M aori and Pacific Peoples had both the highest K-mean and proportions of eyes graded stage IV on the Amsler-Krumeich scale. Conclusions:The results indicate that keratoconus is relatively common in NZ with at least 1869 patients managed by optometrists in 2 years. Most eyes had mild to moderate disease; however, M aori and Pacific Peoples seem to have greater disease severity. An ethnic predilection is apparent, with M aori and Pacific Peoples overrepresented relative to their population proportions, reinforcing a long-held clinical suspicion.

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Prospective Clinical Study of Keratoconus Progression in Patients Awaiting Corneal Cross-linking

Cited by 23 publications

References 39 publications

Forecasting Progressive Trends in Keratoconus by Means of a Time Delay Neural Network

Forecasting Progressive Trends in Keratoconus by Means of a Time Delay Neural Network

Repeatability of corneal and epithelial thickness measurements with anterior segment optical coherence tomography in keratoconus

The Aotearoa Research Into Keratoconus Study: Geographic Distribution, Demographics, and Clinical Characteristics of Keratoconus in New Zealand

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