Official ESCRS | European Society of Cataract & Refractive Surgeons


Detection of early-stage keratoconus using an auto-keratometer: multicenter study

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Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : T.Kojima JAPAN

Co Author(s): :    T. Nishida   T. Nakamura   Y. Satoh   A. Tamaoki   K. Ichikawa   K. Ichikawa        

Abstract Details


Early detection of keratoconus is essential to maintain visual function. Since the auto-ref/keratometer is available worldwide, we evaluated the feasibility of early-stage keratoconus screening using the auto-keratometer measurement values.


Nagoya Eye Clinic, Japan Community Health Care Organization Chukyo Hospital, Japanese Red Cross Gifu Hospital, Satoh Yuya Eye Clinic, and Iida Municipal Hospital.


Grade 1 keratoconus patients and age-/sex-matched healthy control subjects were retrospectively reviewed from patient charts at 5 different hospitals. The subjects were randomly divided into two groups: one for creating the prediction equation and another for verifying it. Multiple logistic regression analysis was performed for the equation group. The diagnosis of keratoconus was set as a dependent variable, and auto-keratometer values, including the average, steep, and flat K values, astigmatism, and astigmatism axis classification, were set as the independent variables. The diagnostic probability was calculated from the regression equation and named as the Keratometer Keratoconus Index (KKI).


We selected 124 keratoconus eyes (patient age: 29.2 ± 14.8 years) and 198 healthy eyes (age of healthy subjects: 27.8 ± 17.3 years). A model was created by logistic regression analysis (p <0.001). Steep K (partial regression coefficient [β]: 1.825; odds ratio [OR]: 6.204), flat K (β: -1.025; OR: 0.359), and with-the-rule astigmatism (β: -4.309; OR: 0.013) were selected as independent variables. The area under the receiver operating characteristic (ROC) curve of KKI was 0.91; the cutoff value of KKI calculated from the ROC curve was 0.32. The sensitivity and specificity in the evaluation group were 82.3% and 88.1%, respectively.


KKI is a promising parameter to detect early-stage keratoconus. If KKI is installed in the auto-keratometer worldwide in the future, there is a possibility that keratoconus will be detected early in many patients. If we can prevent the progression of keratoconus by treatment, such as corneal crosslinking, we believe there is a possibility that further deterioration of visual function can be prevented in many keratoconus patients.

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