Before Keratoconus Begins: Corneal Biomechanical And Tomographical Properties In Children Of Keratoconus Patients

To assess the tomographic and biomechanical data in children with a parental history of keratoconus.

Retrospective single-center study conducted at the ELZA Institute, Zurich, Switzerland.

This retrospective study analyzed 322 eyes of 161 children with at least one parent diagnosed with keratoconus. All underwent Scheimpflug-based corneal tomography (Pentacam HR, Oculus Instruments, Wetzlar, Germany), and 95 children also received biomechanical assessment using high-speed Scheimpflug imaging (Corvis ST, Oculus Instruments). Tomographic abnormalities were defined as BAD-D >1.60 or PRFI >0.125 and pathological values as BAD-D >3.0. Biomechanical abnormalities were defined as CBI >0.50, TBI >0.35, abnormality in either index. Data were analyzed descriptively and stratified by gender and age groups.

Across the full cohort, 31.7% of children showed tomographic abnormalities (BAD-D >1.60) and 11.2% pathological values (BAD-D >3.0). In the tomography + biomechanics group (n=95), abnormal findings were observed in 40.0% for BAD-D >1.60, 53.7% for PRFI, 12.6% for BAD-D >3.0, 51.6% for CBI, 54.7% for TBI, 65.3% for at least one abnormal biomechanical index. Both tomographic and biomechanical abnormalities increased markedly with age. In addition, expert clinical assessment identified keratoconus in 18.6% of children and keratoconus suspect in a further 13.7%.

More than 30% of children with a parental history of keratoconus exhibited early tomographic or biomechanical abnormalities, at rates substantially exceeding those of the general pediatric population. These findings underscore a strong genetic influence on corneal structure and biomechanics and support the need for early screening and pediatric-specific normative data to accurately interpret early deviations in this high-risk group.