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Best Indicators for Detecting Keratoconus Progression in Children: A Report From the Shahroud Schoolchildren Eye
Hassan Hashemi1, Parsa Panahi2, Soheila Asgari1
1Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
Insights
Key indicators like height decentration and Zonal Kmax-3 mm effectively detect keratoconus (KC) progression in children. These changes distinguish KC from normal age-related eye development in those under 12.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Pediatric Eye Care
Background:
- Keratoconus (KC) is a progressive corneal ectasia affecting children and young adults.
- Early detection of KC progression is crucial for timely intervention and management.
- Understanding age-related changes in the cornea is essential to differentiate them from pathological progression.
Purpose of the Study:
- To investigate 3-year changes in keratoconus (KC) indices.
- To identify key indicators of KC progression in children aged 6 to 12 years.
- To compare KC progression with age-related changes in normal eyes.
Main Methods:
- Analysis of 3-year changes (Δ) in vision, refraction, and tomographic indices in progressive KC and normal eyes.
- Diagnosis of KC based on vision, refraction, tomography, and slitlamp examination.
- Determination of the best distinguishing parameters using the area under the curve (AUC).
Main Results:
- All 18 KC eyes analyzed showed progression over 3 years, compared to 10,422 normal eyes.
- Significant differences in Δindices were observed between KC and normal eyes, excluding certain parameters.
- The most effective Δindices for detecting KC progression included index of height decentration and Zonal Kmax-3 mm (AUC > 0.9).
Conclusions:
- Changes in index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry are superior indicators of KC progression in children.
- These indices effectively differentiate KC progression from normal age-related corneal changes in pediatric populations.
- The study highlights specific tomographic and refractive parameters for monitoring pediatric keratoconus.
Purpose:
The purpose of this study was to investigate 3-year changes in keratoconus (KC) indices to determine the indicators of KC progression compared with age-related changes in children aged 6 to 12 years.
Methods:
In this report of the Shahroud Schoolchildren Eye Cohort Study, KC was diagnosed based on vision, refraction, tomography, and slitlamp examination findings. KC progression was defined as changes in refractive astigmatism or zonal maximum keratometry (Zonal Kmax-3 mm). Then, 3-year changes (Δ) in vision, refraction, and tomographic indices were compared between progressive KC and normal eyes. The best set of ∆parameters for distinguishing KC progression from age-related changes were determined using the area under curve (AUC).
Results:
Eighteen KC eyes and 10,422 normal eyes were analyzed. All KC cases showed progression after 3 years. Δindices were statistically different between the 2 groups except corrected distance visual acuity, anterior radius of curvature, irregularity index, and KC percentage index. The best Δindices, in descending order of AUC value, were index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry (all AUC > 0.9), followed by inferior-superior asymmetry, index of surface variance, minimum corneal thickness, index of height asymmetry, KC index, posterior radius of curvature, and Belin/Ambrósio total Deviation (AUC = 0.8-0.9).
Conclusions:
According to our findings, changes in index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry are the best indices for detecting KC progression in children younger than 12 years.
