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Review
. 2025 May 12;12(1):18.
doi: 10.1186/s40662-025-00435-3.

Early diagnosis of keratoconus using corneal biomechanics and OCT derived technologies

Xiaorui Wang  1   2 , Sayo Maeno  3 , Yixin Wang  1 , Shizuka Koh  3 , Shihao Chen  4 , Andrew J Quantock  1 , Siân R Morgan  1 , Sally Hayes  1 , Colm McAlinden  5   6   7
Affiliations
Review

Early diagnosis of keratoconus using corneal biomechanics and OCT derived technologies

Xiaorui Wang et al. Eye Vis (Lond). .

Abstract

Background: Early detection of keratoconus is essential for maximizing the potential of cross-linking treatments designed to halt keratoconus progression, minimizing the risks of iatrogenic ectasia as well as reducing the need for corneal transplantation. This review focuses on the progress that has been made in the early detection of keratoconus using biomechanical and topographical properties derived from three different technologies, namely the ocular response analyser (ORA), corneal visualization Scheimpflug tonometer (Corvis ST) and optical coherence tomography (OCT).

Method: A PubMed search was performed using the keywords of 'early keratoconus', 'subclinical keratoconus', 'forme fruste keratoconus', 'very asymmetric ectasia with normal topography/tomography' and 'ocular response analyser' and/or 'Corvis ST'/'corneal visualized Scheimpflug tomographer/tomography' and/or 'optical coherence tomography/tomographer'.

Results: The integration of biomechanical parameters and corneal morphological data from the topography/tomography or OCT, or the assessment of bilateral asymmetry, has demonstrated improvement in the accuracy of diagnosing early-stage keratoconus.

Conclusions: As measurement principles differ depending on the technique used for keratoconus assessment, comprehensive metrics may be needed to reflect subtle anterior or posterior corneal changes and help identify eyes with very early ectasia. Although clinical experts have always, and will most likely, continue to play a pivotal role in decision-making for early keratoconus diagnosis, future developments in technology and AI may lead to enhanced early detection in the future.

Keywords: Corneal biomechanics; Corneal tomography; Corneal topography; Early stage; Keratoconus; OCT.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approval by the Institutional Review Board/Ethics Committee of Osaka University Hospital (registration number: 09297–20). Data was collected in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants or their parents for those under the age of 18 years. Consent for publication: Not applicable. Competing interests: Outside the submitted work, Dr McAlinden has received consultancy fees/honorarium/travel support (past 36 months) from: Atia Vision (Campbell, California, USA), Bausch and Lomb (Bridgewater, New Jersey, USA), Bayer (Leverkusen, Germany), British Society of Refractive Surgery (Oxford, UK), BVI (Liège, Belgium), Cutting Edge (Labége, France), Hoya (Frankfurt, Germany), Knowledge Gate Group (Copenhagen, Denmark), Johnson & Johnson Surgical Vision (Santa Ana, California, USA), Keio University (Tokyo, Japan), Medevise Consulting SAS (Strasbourg, France), Portuguese Society of Ophthalmology (Coimbra, Portugal), Rayner (Worthing, UK), ROHTO (Tokyo, Japan), Royal College of Ophthalmologists (London, UK), SightGlass vision (Menlo Park, California, USA), Scope (Crawley, UK), SpyGlass (Aliso Viejo, California, USA), Sun Yat-sen University (Guangzhou, China), Thea pharmaceuticals (Clemont-Ferrand, France), Vold Vision (Arkansas, USA). Dr McAlinden developed the Quality of Vision (QoV) questionnaire and the Orthokeratology and Contact Lens Quality of Life Questionnaire (OCL-QoL), and has a financial interest in these tools. He also consults on topics including Rasch analysis, questionnaires, statistical analyses, and clinical/surgical ophthalmology topics. Dr McAlinden has been co-awarded research grants relating to diabetic eye disease from the Welsh Government and the Royal College of Ophthalmologists (unpaid roles) and Catalytic funding from Health and Care Research Wales to develop a Centre for Vision Services Research. Dr McAlinden is a council member and treasurer of the British Society for Refractive Surgery (unpaid role) and a PROM advisor to the Royal College of Ophthalmologists (unpaid role). Dr McAlinden has undertaken paid peer reviews for Research Square (Durham, North Carolina, USA). Dr McAlinden is an editorial board member for Graefe's Archive for Clinical and Experimental Ophthalmology, Eye and Vision, Archives of Medical Science, Journal of Clinical Medicine, Journal of Ophthalmology, and Journal of Clinical and Experimental Ophthalmology. Dr McAlinden is an Associate Editor for Frontiers in Medicine—Ophthalmology.

Figures

Fig. 1
Fig. 1
Illustration of peaks measured with the ocular response analyser in a myopic eye. CRF, corneal resistance factor; CH, corneal hysteresis; p1area, upper 75% area of first peak; H1, height of first peak; H2, height of second peak; W1, width of peak 1 at point of the 25% of the base region W2, width of peak 2 at point of 25% of the base region
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curves of single and combined parameters for forme fruste keratoconus (FFKC) discriminating ability. The discriminating ability accuracies of the Fourier indices were assessed between FFKC and control. ROC curves for each Fourier index for the central 6 mm of the cornea, the asymmetry component of the anterior and the posterior cornea, CBI, TBI, BAD-D, and combined posterior asymmetry and CBI (combined metric) are shown. FFKC eyes had the highest area under the ROC curve (AUROC) values for the combined metric. CBI corneal biomechanical index; TBI, tomographic and biomechanical index; BAD-D, Belin/Ambrósio enhanced ectasia display total deviation
See this image and copyright information in PMC

References

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