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Related Experiment Video

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Validity of keratoconus screening tests.

Zahra A Rashid1, Khathutshelo P Mashige1, Vanessa R Moodley1

  • 1Discipline of Optometry, University of KwaZulu-Natal, Durban, South Africa.

Clinical & Experimental Optometry
|July 22, 2025
PubMed
Summary
This summary is machine-generated.

This study found that combining visual acuity, retinoscopy, and refraction with corneal topography improves keratoconus screening in students. A specific combined criterion offers the most effective early detection of this eye condition.

Keywords:
Astigmatismkeratoconuskeratometryretinoscopyscreening

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Area of Science:

  • Ophthalmology
  • Public Health
  • Optometry

Background:

  • Keratoconus screening in adolescents is crucial for early detection and intervention.
  • Reliable cut-off values for screening tests are needed to facilitate early disease identification.
  • This study evaluated the validity of clinical tests for keratoconus screening in high school students.

Purpose of the Study:

  • To compare the effectiveness of various clinical tests in screening for keratoconus among high school students.
  • To identify optimal referral criteria for keratoconus detection in an adolescent population.
  • To establish reliable cut-off values for keratoconus screening.

Main Methods:

  • A population-based, prospective, cross-sectional study involving multistage cluster sampling of 3051 students (mean age 17.4 years).
  • Participants underwent visual acuity assessment, auto-refraction, retinoscopy, and corneal topography.
  • Students were categorized into non-keratoconus, keratoconus suspect, and keratoconus groups.

Main Results:

  • Of 3051 students, 51 (1.7%) were diagnosed with keratoconus.
  • Keratoconus patients showed worse visual acuity, more myopia, and higher astigmatism compared to controls (p < 0.05).
  • A combined referral criterion (scissors reflex on retinoscopy OR max anterior corneal curvature >46.5 D OR astigmatism >2.50 D) demonstrated the highest Youden Index (0.46).

Conclusions:

  • Monocular visual acuity, retinoscopy, keratometry, and refraction, alongside corneal topography, should be integrated into keratoconus screening protocols.
  • A recommended combined referral criterion includes a scissors reflex on retinoscopy, maximum anterior corneal curvature >46.5 D, or astigmatism >2.50 D.
  • This approach enhances the effectiveness of early keratoconus detection in student populations.