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New keratoconus grading system based on OCT: threshold adjustment for SS-OCT.

Nan-Ji Lu¹, Frederik Raiskup, Lutz E Pillunat

¹From the Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China (Lu); Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany (Raiskup, Pillunat, Herber); National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China (Wang, Cui); State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China (Wang, Cui).

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Summary

The STEP keratoconus grading system shows good performance with swept-source OCT (SS-OCT) for epithelium thickness but requires adjusted thresholds for stroma thickness. Discrepancies between SS-OCT and SD-OCT highlight considerations for clinical practice.

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Area of Science:

Ophthalmology
Medical Imaging
Biomedical Engineering

Background:

Keratoconus (KC) is a progressive corneal disease affecting vision.
Accurate thickness measurements are crucial for KC diagnosis and management.
Optical coherence tomography (OCT) technologies, including swept-source OCT (SS-OCT) and spectral-domain OCT (SD-OCT), offer advanced imaging capabilities.

Purpose of the Study:

To evaluate the performance of the STEP keratoconus grading system utilizing SS-OCT.
To compare the accuracy of thickness measurements between SS-OCT and SD-OCT devices.
To assess the agreement of SS-OCT derived STEP parameters with established keratoconus grading systems.

Main Methods:

A retrospective case-control study involving university hospitals in Germany and China.
Analysis of data from 152 normal and 314 KC eyes using Rotating Scheimpflug tomography (RSC, Pentacam) and SS-OCT (ANTERION).
Comparison of STEP system parameters (stroma thinnest thickness [ST] and epithelium SD [EP]) derived from SS-OCT with RSC ABC system and assessment of interdevice agreement with SD-OCT (RTVue-XR) using Bland-Altman plots and linear regression.

Main Results:

The STEP epithelium (EP) parameter demonstrated good agreement with the RSC ABC system in normal and KC eyes.
The STEP stroma thinnest thickness (ST) parameter showed lower agreement with the RSC 'C' metric in KC eyes, necessitating threshold adjustments.
SS-OCT estimated stroma thickness values were higher than those from SD-OCT, with mean differences of 23.18 μm (normal) and 20.91 μm (KC eyes).

Conclusions:

SS-OCT's STEP EP parameter aligns well with the RSC ABC system for keratoconus assessment.
Adjusted thresholds for SS-OCT's STEP ST are required for accurate clinical application.
Observed thickness measurement discrepancies between SS-OCT and SD-OCT warrant careful consideration for future clinical practice and research in keratoconus management.