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Evaluation of parameters for early detection of pediatric keratoconus
Sharon H Zhao1, Carla Berkowitz2, Hantamalala Ralay Ranaivo3
1Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. sharon.zhao@northwestern.edu.
Insights
Pediatric keratoconus screening using Scheimpflug imaging (Pentacam) identified that older age, reduced visual acuity, oblique astigmatism, and corneal findings correlate with abnormal results, aiding early detection.
Area of Science:
- Ophthalmology
- Corneal Imaging
- Pediatric Eye Care
Background:
- Pediatric keratoconus is often severe and progresses rapidly.
- Established pediatric screening guidelines for keratoconus are lacking.
- Scheimpflug imaging (Pentacam) aids screening but requires pediatric-specific interpretation.
Purpose of the Study:
- To correlate clinical factors with abnormal Scheimpflug imaging (Pentacam) results in pediatric patients.
- To aid in the development of pediatric screening protocols for keratoconus.
- To identify clinical indicators associated with abnormal keratoconus screening in children.
Main Methods:
- Retrospective cohort analysis of 78 patients aged 3-18 years screened for keratoconus.
- Utilized Scheimpflug imaging (Pentacam) and compared indices (final D, ART max, CAIRO 8) to established pediatric ranges.
- Correlated clinical findings (astigmatism, visual acuity, slit lamp examination) with imaging results.
Main Results:
- 70% of patients exhibited indeterminate or keratoconus values on Pentacam screening.
- Patients classified as keratoconus were older, had worse visual acuity, and more oblique astigmatism.
- Clinical factors like oblique astigmatism and corneal abnormalities on examination were associated with abnormal Pentacam findings.
Conclusions:
- Older age, lower visual acuity, oblique astigmatism, and corneal findings are associated with abnormal pediatric keratoconus screening via Pentacam.
- The majority of clinically suspicious pediatric cases showed abnormal or indeterminate Scheimpflug imaging indices.
- Further research will focus on identifying clinical risk factors for keratoconus progression in children.
Background:
Keratoconus in children is often more severe and rapidly progressive compared to adults. While Scheimpflug imaging (Pentacam) improves screening, there are no established pediatric guidelines. Due to challenges in diagnosis, we aimed to correlate clinical factors with abnormal imaging results to aid in the development of screening protocols.
Methods:
A single-center retrospective cohort analysis of patients 3-18 years screened for keratoconus with ophthalmic examination and initial Scheimpflug imaging between 2021 to 2023. Scheimpflug indices including final D, ART max, and calculated CAIRO 8, which is a corneal metric combining pachymetry, ART max, and elevation, were compared to published pediatric ranges for normal and keratoconus corneas.
Results:
Seventy-eight patients (11.8 ± 3.9 years) were screened with the majority referred due to high and/or progressive astigmatism (74 patients, 94%). Forty-nine patients (63%) were male and 48 (62%) self-reported Hispanic ethnicity. Average astigmatism was 4.9 ± 1.8 D and 86% had with-the-rule astigmatism. Fourteen patients (18%) had corneal findings on slit lamp. Average LogMAR CDVA was 0.243 ± 0.274 D. By Pentacam, 55 (70%) patients had ≥ 1 indeterminate or keratoconus value. Patients stratified as keratoconus by all parameters were older (15 vs. 11 years, p = 0.015-0.02), had worse visual acuity (p < 0.0001), and were more likely to have oblique astigmatism (0.0002-< 0.0001) and corneal abnormalities on examination (p < 0.00001) compared to eyes with normal or indeterminate indices.
Conclusions:
Older age, lower visual acuity, oblique astigmatism, and corneal findings were more commonly found in patients with abnormal screening Pentacam. Most patients clinically suspicious for keratoconus had ≥ 1 indeterminate/abnormal indices. Future studies will follow these patients to identify clinical risk factors for progression.
