Corneal High-Order Aberrations in Keratoconus

Juan C. Arciniega, MD; Engy M. Mohamed, MD; R. Wayne Bowman, MD; Steven Verity, MD; James P. McCulley, MD, FRCOphth (UK). Department of Ophthalmology, The University of Texas Southwestern Medical Center at Dallas, Texas. USA. Financial Disclosure:
Juan C. Arciniega, Engy M. Mohamed, Steven Verity and R. Wayne Bowman have no commercial relationships. James P. McCulley is a consultant of Alcon Inc. This study was supported in part by grants NIH EY12430, EY016664 and an unrestricted grant from the Research to Prevent Blindness, New York, New York.

Background
Keratoconus is a condition in which the cornea assumes a conical shape as a result of non-inflammatory progressive corneal thinning. The thinning and protrusion in keratoconus induces irregular astigmatism with and without myopia resulting in mild to marked impairment in both quantity and quality of vision. It is a progressive disease ultimately affecting both eyes, although only one eye may be affected initially.1

1) Kanski Jack, Clinical Ophthalmology. Sixth edition, Elsevier, 2007

Purpose
To evaluate the use of the anterior and posterior corneal surface highorder aberrations (HOAs) as a tool to detect and grade keratoconus using the Pentacam.

Methods
A retrospective study of 111 eyes (62 patients; 33 males) was performed. The eyes were divided into 5 groups: suspect group and four other groups according to the Amsler-Krumeich classification of keratoconus: stage I to stage IV groups. Anterior and posterior corneal HOAs were obtained using the software provided by the Pentacam system.

Methods
The Amsler-Krumeich classification1 includes the following stages:
Stage I

Eccentric steeping Myopia and astigmatism < 5.00 D Mean central K readings < 48.00 D
Myopia and astigmatism from 5.00 to 8.00 D Mean central K readings < 53.00 D Absence of scarring Minimum corneal thickness >400 m. Myopia and astigmatism from 8.00 to 10.00 D Mean central K readings >53.00 D Absence of scarring Minimum corneal thickness 300 to 400 m. Refraction not measurable Mean central K readings >55.00 D Central corneal scarring Minimum corneal thickness 200 m

Stage II

Stage III

Stage IV

1) Ali Jorge, Corneal Higher Order Aberrations: A Method to Grade Keratoconus. J Refract Surg. Vol. 22 No. 6 June 2006

Methods
Anterior & Posterior Zernike (Z) coefficients were used from Z3 to Z6 to calculate:

Coma-like aberration
Spherical-like aberration Residual aberrations

Results
The mean age of patients was 49.46.7 years. The mean keratometric value was 43.3014 D The mean thinnest point of corneal thickness was 450.887m.
Number of Patients Eye number Right eye Left eye Males Females Stage I Stage II Stage III Stage IV Suspect 62 111 58 53 33 29 43 24 8 21 15

Results
Patients Demographics

Suspect Age Mean keratometric value Corneal thickness Sphere Cylinder Spherical equivalent 41.918.5 43.61.9 519.840.6 -4.43.3 2.31.4 -3.23.1

Stage I 44.511.8 44.81.9 490.444.4 -5.13.5 3.51.9 -3.43.4

Stage II 41.916.6 49.91.4

Stage III 43.115.9 53.80.55

Stage IV 43.912 60.55.3

437.245.1 413.674.1 349.9117 -9.73.2 2.62.5 -5.53.3 -8.73.7 4.51.8 -6.54 -9.74.7 4.53 -7.44

Results
Posterior coma-like aberration was the highest posterior HOAs among all the groups and anterior coma-like aberration was the highest of anterior HOAs among all groups except for the suspect group which had the anterior spherical-like aberration as the highest.

Anterior coma-like aberrations increased progressively with the groups while the posterior coma-like aberrations did not show a gradually increase.

Results

Conclusion
Corneal higher-order aberrations, especially coma-like aberrations, are significantly higher in eyes with keratoconus than in keratoconus suspects. Only anterior coma-like aberrations measured by Pentacam were best in the early detection and grading of keratoconus.