Multimodal Screening Combining Epithelial Thickness Mapping And Corneal Biomechanics For Early Detection Of Subclinical Keratoconus
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR356 | Type: Poster | DOI: 10.82333/zyca-1b98
Authors: Mrs Ghita Halfi* 1 , A/Prof. ibrahimi fatima 1 , A/Prof. akannour younes 1 , A/Prof. serghini louai 1 , A/Prof. chariba siham 1 , A/Prof. abdallah elhassan 1
1speciality hospital,rabat,Morocco
Purpose
Undetected subclinical keratoconus remains a leading cause of postoperative ectasia after refractive surgery. Conventional tomography may fail to detect early biomechanical instability when anterior curvature appears normal. This study evaluated whether a multimodal approach integrating epithelial thickness mapping and dynamic corneal biomechanical assessment enhances early detection of subclinical keratoconus in refractive surgery candidates.
Setting
Tertiary referral university hospital, Department of Ophthalmology
Methods
This prospective study included 96 eyes (96 patients) stratified into three groups: clinical keratoconus (n=32), subclinical keratoconus (n=32), and normal controls (n=32). All eyes underwent standardized corneal imaging including Scheimpflug tomography, spectral-domain anterior segment OCT epithelial thickness mapping, and dynamic corneal response analysis using the Corvis ST.
Primary endpoints were epithelial thickness variability, inferior–superior epithelial asymmetry, and composite biomechanical index values. Diagnostic accuracy of each modality and the combined model was assessed using receiver operating characteristic (ROC) curve analysis.
Results
Subclinical keratoconus eyes demonstrated a distinct epithelial remodeling pattern characterized by focal inferior thinning with compensatory paracentral thickening (p<0.001), despite normal anterior curvature maps. Epithelial variability and inferior–superior asymmetry were significantly increased compared to controls.
Biomechanical indices revealed early corneal weakening in subclinical eyes (p<0.01), even when tomographic parameters remained within normal limits.
The integrated multimodal model significantly outperformed tomography alone, achieving an AUC of 0.94 versus 0.81. Importantly, 28% of eyes considered normal by standard topography were reclassified as high-risk when epithelial and biomechanical data were combined.
Conclusions
Multimodal corneal screening integrating epithelial thickness mapping and dynamic biomechanical assessment provides superior sensitivity for detecting subclinical keratoconus compared with tomography alone. This strategy enables earlier identification of biomechanically vulnerable corneas and may substantially reduce the risk of postoperative ectasia. Implementation of combined diagnostic algorithms has the potential to redefine refractive surgery safety standards