Comparative Diagnostic Efficacy of Swept-Source OCT and Scheimpflug Imaging in Clinically Unaffected Eyes of Very Asymmetric Ectasia.

PURPOSE: To determine the diagnostic ability of corneal tomography indices for detecting corneal ectasia using a swept-source OCT system (SS-OCT; ANTERION), a rotating Scheimpflug camera system (Pentacam HR), and a dynamic ultra-high-speed Scheimpflug noncontact tonometry and cornea analyzer (Corvis ST).

DESIGN

A prospective cross-sectional study.

SUBJECTS: Participants were assigned to a healthy group (N = 228), a bilateral keratoconus group (N = 308), with 1 eye randomly selected, or a very asymmetric ectasia group with no clinical ectasia signs (VAE-NES, n = 91), with the unoperated fellow eye having clinical ectasia (VAE-E, n = 75).

METHODS

All participants underwent examination with all devices. The following indices were analyzed: Screening Corneal Objective Risk of Ectasia (SCORE), tomographical and biomechanical index (TBI, version 2), Pentacam random forest index (PRFI), Belin/Ambrósio total deviation value (BAD-D, version 3), and Corvis biomechanical index.

MAIN OUTCOME MEASURES: Comparison of the area under the curve (AUC) from receiver operating characteristic (ROC) curve analyses.

RESULTS

When differentiating VAE-NES from healthy eyes, ROC analysis showed a significantly higher AUC for SCORE (0.888) compared with PRFI (0.765; P < 0.001) and BAD-D (0.686; P < 0.001), but not TBI (0.847; P = 0.06). Sensitivity and specificity were 75% and 85% for SCORE, 58%/86% for PRFI, 41%/90% for BAD-D, and 77%/81% for TBI, respectively. In distinguishing healthy eyes from all ectatic eyes, AUC values were 0.978 for SCORE, 0.955 for PRFI, and 0.936 for BAD-D (all P < 0.001). Tomographical and biomechanical index (AUC 0.968) and SCORE were comparable (P = 0.06).

CONCLUSIONS

Screening Corneal Objective Risk of Ectasia derived from SS-OCT and TBI from integrated Scheimpflug imaging demonstrated the highest and comparable diagnostic performance for detecting clinically unaffected fellow eyes without clinical ectasia signs but with ectasia susceptibility (VAE-NES).

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.