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Detecting Keratoconus: Feasibility and Findings in Three Pediatric Risk Groups
Insights
Pediatric patients with Trisomy 21 completed fewer corneal screening tests reliably, showing thinner corneas and lower resistance. Standard keratoconus screening may not be suitable for all high-risk children.
Area of Science:
- Ophthalmology
- Genetics
- Medical Devices
Background:
- Keratoconus screening in pediatric populations presents unique challenges.
- Trisomy 21 is associated with ocular abnormalities, necessitating careful screening.
- Evaluating corneal health in children requires reliable and adaptable diagnostic tools.
Purpose of the Study:
- To assess the utility of three distinct corneal screening devices (Pentacam, Orbscan, Ocular Response Analyzer) in pediatric patients.
- To compare the performance of these devices across three groups: children with Trisomy 21, those with a family history of keratoconus, and healthy controls.
- To determine the reliability and quality of data obtained from these devices in diverse pediatric cohorts.
Main Methods:
- A prospective study enrolled 54 children (ages 7-17) into three groups: Trisomy 21, familial keratoconus risk, and controls.
- Corneal screening was performed using Pentacam, Orbscan, and Ocular Response Analyzer (ORA) after obtaining informed consent.
- Data collected included test completion rates, result quality, and key corneal parameters; statistical analysis used one-way ANOVA.
Main Results:
- Children with Trisomy 21 (Group 1) had significantly lower test completion rates (55%) compared to familial risk (87%) and control groups (88%).
- Pentacam revealed thinner corneas (thinnest point) and lower keratometry in Group 1 (P=.03, P=.01). Orbscan showed thinner central corneal thickness and thinnest point in Group 1 (P=.01, P<.0001).
- ORA indicated lower corneal resistance factors in Group 1 (P=.03) and significantly poorer quality scores across all devices for Group 1 (P<.0001).
Conclusions:
- Pediatric patients with Trisomy 21 exhibited challenges in completing corneal screening tests reliably, yielding thinner corneas and reduced corneal resistance.
- The findings suggest that standard keratoconus screening protocols and devices may not be sufficiently reliable for evaluating certain high-risk pediatric populations, including those with Trisomy 21.
- Further research is warranted to develop and validate specialized screening methods for pediatric patients at high risk for corneal abnormalities.
Purpose:
To investigate the utility of three corneal screening devices in three groups of children.
Methods:
This was a prospective study of patients with Trisomy 21 (group 1), patients with a first-degree relative with keratoconus (group 2), and control patients (group 3). Informed consent was obtained before testing with the Pentacam (Oculus Optikgeräte GmbH), Orbscan (Orbscan, Inc), and Ocular Response Analyzer (ORA) (Ametek Reichart Technologies). The ability to complete tests, the quality of results, and the corneal parameters obtained for each eye were recorded. A one-way analysis of variance test was used to compare the results between the three groups.
Results:
Fifty-four patients aged from 7 to 17 years (mean: 11.74 years) were enrolled between July 2014 and July 2016. The number of patients and the percentage of tests completed for groups 1, 2, and 3 were 12 (55%), 21 (87%), and 21 (88%), respectively. The Pentacam values by group were central corneal thickness of 524, 543, and 542 µm (P = .36); thinnest point of 498, 536, and 534 µm (P = .03); corneal front mean keratometry of 44.9, 43.2, and 43.2 (P = .01); and quality score of 1.42, 0.22, and 0.04 (P < .0001), respectively. Orbscan values by group were central corneal thickness of 493, 551, and 550 µm (P = .01) and thinnest point of 451, 536, and 538 µm (P < .0001), respectively. ORA values by group were corneal hysteresis of 10.6, 12.1, and 11.6 (P = .124); corneal resistance factor of 9.9, 11.8, and 11.6 (P = .03); and waveform score of 5.6, 7.6, and 7.3 (P < .0001), respectively.
Conclusions:
Patients in group 1 completed fewer tests reliably and had thinner corneas and lower corneal resistance factors than patients in groups 2 and 3. Corneal tests used to evaluate adults for keratoconus may not be reliable for the evaluation of certain high-risk pediatric patients. [.
