Quantitative Corneal Epithelial Wavefront Aberrations For Precise Detection Of Keratoconus And Forme Fruste Keratoconus
Published 2026 - 44th Congress of the ESCRS
Reference: FP06.01 | Type: Free paper | DOI: 10.82333/tvk5-n102
Authors: Dr Jinhai Huang* 1 , Dr Rui Ning 2 , Dr Chak Seng Lei 1 , A/Prof. Xingtao Zhou 1 , A/Prof. Xiaoying Wang 1
1Eye & ENT Hospital, Fudan University,Shanghai,China, 2Refractive center, the Affiliated Hospital of Yunnan University,Kunming,China
Purpose
To rigorously evaluate the discriminative performance of corneal epithelial wavefront aberrations in distinguishing forme fruste keratoconus (FFKC) and clinically manifest keratoconus (KC) from normal corneas.
Setting
Eye & ENT Hospital, Fudan University
Methods
326 right eyes (91 normal, 87 FFKC, 148 KC) were imaged with anterior-segment optical coherence tomography. Epithelial aberrations within a 6-mm zone were decomposed into Zernike coefficients; total RMS, HOAs RMS, coma, trefoil, spherical and secondary astigmatism were extracted. Stepwise logistic regression generated composite epithelial aberration indices (EAI-FFKC, EAI-KC). Diagnostic accuracy was assessed by area under the ROC curve (AUC) with sensitivity and specificity.
Results
Epithelial HOAs were significantly elevated in both FFKC and KC cohorts compared with normal eyes (all P < 0.001). In the FFKC versus normal comparison, HOAs RMS and coma yielded AUCs of 0.714 (95 % CI 0.647–0.781) and 0.788 (0.725–0.850), respectively. The composite EAI-FFKC maximized discriminatory power (AUC 0.822; 95%CI 0.768–0.877) with 77.0% sensitivity and 75.8% specificity. For KC versus normal, HOAs RMS exhibited AUCs ranging from 0.976 to 0.998 (sensitivity 95.2 %–100%, specificity 92.3%–96.7%), while coma reached AUCs of 0.974–0.997 (sensitivity 92.9%–100%, specificity 96.7%–98.9%). The integrated EAI-KC achieved near-perfect separation (AUC 0.996; 95% CI 0.993–0.999), with 98.6 % sensitivity and 98.9 % specificity.
Conclusions
Epithelial wavefront analysis tracks abnormal epithelial remodeling throughout the entire keratoconus spectrum, from subclinical forme fruste to advanced ectasia, establishing epithelial aberrations as a robust, non-invasive biomarker for diagnosing both KC and FFKC.