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Enhanced morphological assessment based on interocular asymmetry analysis for keratoconus detection
Ruilan Dong1,2,3, Yan Liu1,2,3, Yu Zhang1,2,3
1Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Summary
Interocular asymmetry in corneal shape is a key indicator for detecting keratoconus (KC) and subclinical KC. This asymmetry, especially in keratometry and aberrations, significantly aids in diagnosing KC, even in early stages.
Area of Science:
- Ophthalmology
- Corneal Imaging
- Biometry
Background:
- Keratoconus (KC) is a progressive thinning of the cornea.
- Accurate diagnosis of KC and subclinical KC (SKC) is crucial for timely intervention.
- Interocular differences in corneal morphology are increasingly recognized as important diagnostic markers.
Purpose of the Study:
- To investigate the interocular asymmetry of corneal morphological descriptors.
- To assess the diagnostic capability of this asymmetry for keratoconus.
- To evaluate its utility in detecting subclinical keratoconus.
Main Methods:
- Retrospective analysis of 344 normal participants and 290 KC patients.
- Evaluation of 44 corneal morphological descriptors from Schiempflug tomography.
- Logistic regression models using binocular data and diagnostic performance metrics (AUC, NRI, IDI).
Main Results:
- Interocular agreement was generally higher in normal eyes than in KC eyes.
- Interocular asymmetry increased with KC severity.
- Asymmetry in keratometry and higher-order aberrations showed high diagnostic accuracy (AUC > 0.950).
- Binocular analysis significantly improved KC detection (AUC 0.963) and was particularly beneficial for SKC detection.
Conclusions:
- Interocular asymmetry is a significant feature of KC, correlating with disease severity.
- This asymmetry can be effectively used to diagnose KC and SKC, complementing monocular measurements.
- It holds potential for monitoring disease progression.
