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Detection of keratoconus in the topographically normal fellow eyes of unilateral keratoconus using epithelial thickness analysis

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Session Details

Session Title: Imaging Anterior Segment

Session Date/Time: Monday 07/09/2015 | 14:30-16:30

Paper Time: 15:20

Venue: Room 11

First Author: : M.Gobbe UK

Co Author(s): :    D. Reinstein   T. Archer   R. Urs   A. RoyChoudhury   R. Silverman        

Abstract Details


Although keratoconus is regarded as a bilateral disease, in some instances, patients may present unilaterally. Such fellow eyes are considered to be helpful in assessing early keratoconus screening methods. In this study, we assessed the effectiveness of a keratoconus -detection algorithm derived from Artemis very high frequency ultrasound epithelial thickness maps in a series of unilateral keratoconus subjects.


London Vision Clinic, London, UK.


The study included 10 patients with moderate to advanced keratoconus in one eye but a clinically and topographically normal fellow eye. We acquired Artemis epithelial thickness data and applied a previously developed classification model for identification of keratoconus to the clinically normal fellow eyes. Pentacam HD Belin-Ambrosio Display (BAD) data, available for 5 of the 10 eyes, were also evaluated.


Five of the 10 fellow eyes were classified as keratoconus by the Artemis epithelium model. For the 5 fellow eyes with Pentacam HD and Artemis data, one was classified as keratoconus by the Artemis model, one (different) eye by a combined Artemis and Pentacam HD model, and none by BAD-D alone.


Under the assumption that keratoconus is a bilateral, but asymmetric disease, we demonstrated that half of the ‘normal' fellow eyes could be found to have keratoconus by using epithelial thickness maps. The combination of topographic BAD criteria with epithelial maps did not appear to perform better. It is possible that this population included patients who were truly monocularly keratoconic. Alternatively, it may be that the phenotypically unexpressed form of keratoconus might actually be undetectable by anatomical analysis.

Financial Interest:

One of the authors has significant investment interest in a company producing, developing or supplying product or procedure presented

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