Ultrasound-based ocular pulse elastography shows great diagnostic and grading performance for keratoconus eyes

To compare the performance of ocular pulse elastography with corneal tomography and topography in keratoconus diagnosis.

This study utilised an open-access dataset of corneal imaging. A total of 35 eyes with a clinical diagnosis of keratoconus and 38 normal eyes were recruited. Patients underwent intraocular measurement, ocular pulse elastography, corneal tomography and topography. Central corneal thickness, corneal axial displacement and stiffness index were obtained from ocular pulse elastography, and thinnest pachymetry and maximum keratometry (Kmax) were reported from corneal tomography and topography. In addition, we evaluated the diagnostic performance of ocular pulse elastography in comparison with corneal tomography and topography.

The ocular pulse elastography diagnostic model, incorporating parameters of central corneal thickness, stiffness index and corneal axial displacement, demonstrated an excellent area under the curve of 0.934 with a sensitivity of 91.4% and a specificity of 81.5%. Among the parameters, central corneal thickness demonstrated the best diagnostic performance, achieving an area under the curve of 0.919, a sensitivity of 97.1% and a specificity of 73.7%. Furthermore, the direct comparison of areas under the curve between the ocular pulse elastography model and corneal curvature-to-thickness (Kmax divided by thinnest pachymetry) revealed a non-significant difference (confidence interval = -0.006 to 0.065, p = 0.112).

In this study, ocular pulse elastography demonstrated excellent diagnostic performance comparable to corneal tomography and topography. These findings suggest that ocular pulse elastography might be incorporated as a promising diagnostic method in keratoconus management, similar to corneal tomography and topography.