Official ESCRS | European Society of Cataract & Refractive Surgeons


Intrasubject repeatability of epithelial thickness and its relation to visual acuity in keratoconus patients

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Session Details

Session Title: Presented Poster Session: Corneal Cross-Linking

Venue: Poster Village: Pod 3

First Author: : A.Vega-Estrada SPAIN

Co Author(s): :    M. Mimouni   E. Espla   J. Alió Del Barrio   J. Alió              

Abstract Details


To evaluate intra-subject repeatability of anterior segment optical coherence tomography (AS-OCT) combined with placido disc MS-39 (CSO, Firenze, Italy) and correlate epithelial thickness measurements and the degree of visual limitation in keratoconus patients.


Vissum Innovation, Alicante. Spain


Prospective, observational, clinical study including167 eyes of which 107 were from keratoconus patients and 60 were healthy. Three repeated consecutive epithelial thickness measurements were taken: central 3.0 mm and the nasal, temporal, superior, and inferior regions at 3.0-6.0 mm and 6.0-8.0 mm. Intra-subject repeatability of epithelial indices was assessed and correlated to the degree of corrected visual acuity (BCVA)


The intraclass correlation coefficient was ≥ 0.90 indicating highly repeatable measurements for both keratoconus and healthy eyes. In multivariate analysis, epithelial indices associated with worse BCVA were: thinner 3mm central (p=0.04), thicker 8mm superior (p<0.001) and thinner 8mm inferior (p<0.001). Thickness central 3mm decreased as keratoconus grading increased (p=0.002). The superior-inferior ratio at 8mm significantly increased as keratoconus grading increased (p<0.001). Multivariate analysis thinner 3mm central (R2=6.19%, p=0.04), greater superior-inferior 8mm ratio (R2=8.37%, p=0.004), greater superior-inferior 6mm ratio (R2=2.67%, p=0.02), and steeper K2 (R2=21.51%, p<0.001) were associated with keratoconus with combined area under the curve of 0.92.


High repeatability of epithelial thickness measurements may be achieved in both keratoconus and healthy eyes with the MS-39. There is a significant correlation between epithelial thickness measurements and BCVA. These measurements may be of additional value in discriminating between keratoconus and healthy eyes.

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