Related Experiment Video
Updated: Oct 21, 2025
Full-Field Optical Coherence Microscopy for Histology-Like Analysis of Stromal Features in Corneal Grafts
Published on: October 21, 2022
The ABCD Keratoconus Grading System-A Useful Tool to Estimate Keratoconus Progression in the Pediatric Population
Biana Dubinsky-Pertzov1, Ophir Reinhardt, Inbal Gazit
1Department of Ophthalmology, Shamir Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Insights
The ABCD grading system effectively tracks pediatric keratoconus progression. Worsening ABCD scores indicate a higher risk for needing corneal crosslinking (CXL), unlike the Amsler-Krumeich classification.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Corneal Diseases
Background:
- Keratoconus is a progressive thinning of the cornea.
- Early detection and monitoring of keratoconus progression are crucial in pediatric patients.
- Existing grading systems may have limitations in assessing pediatric keratoconus progression.
Purpose of the Study:
- To evaluate the utility of the ABCD grading system for assessing keratoconus progression in children.
- To compare the ABCD grading system's effectiveness against the Amsler-Krumeich classification in pediatric keratoconus.
Main Methods:
- Retrospective cohort analysis of 50 pediatric keratoconus patients (2010-2017).
- Corneal crosslinking (CXL) recommendation served as a proxy for clinically significant progression.
- ABCD grading was calculated post hoc and compared between CXL and stable groups.
Main Results:
- The ABCD staging significantly increased in eyes requiring CXL (P < 0.001), but remained stable in non-CXL eyes (P = 0.87).
- A one-point increase in ABCD staging correlated with a 5-fold increased risk of requiring CXL (OR = 5.28).
- The Amsler-Krumeich classification showed no significant change in the CXL group.
Conclusions:
- The ABCD grading system is a valuable tool for monitoring keratoconus progression in pediatric patients.
- Changes in ABCD grading are associated with disease progression, aiding in timely intervention decisions.
- The ABCD system offers a more sensitive measure of progression in pediatric keratoconus compared to the Amsler-Krumeich classification.
Purpose:
To evaluate the ABCD grading system in pediatric keratoconus.
Methods:
A retrospective cohort analysis of all children with keratoconus followed up at the Shamir medical center between 2010 and 2017. A recommendation by the treating physician to undergo corneal crosslinking (CXL) was used as an estimate for clinically significant disease progression. The ABCD grading was not available to the treating physician and was computed post hoc. The ABCD grading was compared between patients who required CXL with those who did not. A single eye of each patient was included.
Results:
Fifty eyes of 50 children were analyzed. The mean age at presentation was 15.56 ± 1.36 years. In 23 eyes, progression of keratoconus was recorded and CXL was performed (CXL-group). On presentation, the stable and CXL groups did not differ significantly in their clinical parameters. In the CXL-group, a statistically significant increase was seen in the ABCD staging (P < 0.001). In the stable group, the ABCD staging did not change significantly in parallel visits (P = 0.87). An increase of 1 point in the sum of the ABCD staging showed a 5-fold risk for undergoing CXL (odds ratio = 5.28; 95% CI, 1.82-15.34). There was no significant change in the Amsler-Krumeich classification in the CXL group.
Conclusions:
Among a cohort of pediatric patients with keratoconus, worsening in the ABCD grading was associated with disease progression, whereas no significant change was demonstrated in the Amsler-Krumeich classification The ABCD grading system is a useful tool for initial assessment of disease progression in the pediatric population, in which early recognition is of paramount importance.
More Related Videos
07:29Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
05:10Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023