Comparison Of Two Scoring Systems For Detecting Early Forms Of Keratoconus And Their Correlation With Collagen Properties.

To evaluate the efficacy of the new K SCORE, implemented in ANTERION, in comparison to the widely accepted BAD-D score from Pentacam AXL Wave for the early detection of ectasia. Additionally, we sought to establish correlations between these parameters and collagen distribution and orientation using polarization-sensitive OCT (PS-OCT).

Tertiary Eye-care Centre, India.

We conducted a prospective study involving 200 eyes of 200 patients undergoing refractive surgery, with one eye randomly chosen for inclusion. All eyes underwent scanning with Pentacam AXL Wave (rotating Scheimpflug technology) and ANTERION (anterior segment optical coherence tomography) to derive respective ectasia scores. Agreement between the parameters used by the two-classification software was assessed using the intraclass correlation coefficient (ICC) and paired sample t-test. The efficacy of the scoring systems was evaluated through receiver operating characteristic (ROC) curve analysis, further correlated with Phase retardation maps on PS-OCT.

Anterior surface keratometry (K) parameters K1, K2, and astigmatism exhibited mean differences and confidence intervals of -0.2 [-0.25, -0.16] D, -0.21 [-0.25, -0.16] D, and -0.01 [-0.05, 0.03] D, respectively. These parameters were significantly different between the devices in the t-test (p < 0.001), but the differences were not clinically relevant (<0.25 D). ICC for these parameters exceeded 0.92. ROC analysis of BAD-D showed 94.74% sensitivity and 99.18% specificity, while ROC analysis of K SCORE demonstrated 92.86% sensitivity and 91.79% specificity. Patients with a weak K-score and a suspicious BAD-D exhibited poor collagen orientation and distribution on PS_OCT.

In summary, ANTERION and Pentacam AXL Wave parameters displayed good agreement. The sensitivity and specificity of the K SCORE were comparable to BAD-D. An abnormal K-Score on ANTERION correlated with weak collagen properties, affirming the validity of both scoring systems.