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The vital-A classification schema for keratoconus: preparing for the new paradigm shift in treatment

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Session Details

Session Title: Corneal Biomechanics

Session Date/Time: Monday 15/09/2014 | 17:00-18:30

Paper Time: 17:30

Venue: Capital Hall A

First Author: : A.Charonis GREECE

Co Author(s): :    C. Katsoulos   A. Manaios   G. Kosti        

Abstract Details


To describe a new paradigm shift in classifying keratoconus that makes clinical sense.


Athens Vision private eye Institute


100 patients in our keratoconus database were included to highlight the difference of the VITAL classification system to the Amsler Krumeich classification. Best spectacle corrected vision (VI) Topographical cone area (T), Peak-Value corneal WFE at 6mm as a marker of the theoretical ablation volume needed to regularize the surface(A) and anterior chamber length (L) , are all included as independent variables in the VITAL classification system. Additional denominators as topographical stability and apical scarring are also included.


The patient receives a Vital score for each denominator from 1-4: (Vi) BSCVA, (T) tomography, (A) Ablation –derived from the Peak-Valley metric of the corneal wavefront and (L) Length, referring to the anterior chamber depth. Additional underscripts to determine relevant clinical determinants as topographical stability and apical scarring are also included. (VΙ1T4sA2L1) Despite positive correlation with the Vital classification, the Amsler Krumeich classification failed to identify more than 70% of individual determinants of the Vital classification.


Derived from the famous TNM classification concept, the VITAL classification may prove valuable to dictate treatment for CXL-PRK, phakic lenses, Intracorneal Rings, AMART , Gregory Lens placement or more invasive techniques as DALK and allow communication between corneal surgeons

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