[Diagnostic innovations for the early detection and characterization of keratoconus]

Keratoconus is a progressive, ectatic corneal disease with considerable potential for visual impairment, especially in advanced stages. Early and precise diagnostics are crucial to avoid progression of the disease.

Modern diagnostic procedures for recognizing keratoconus, including subclinical stages are presented and evaluated.

Analysis of current imaging and biomechanical procedures, e.g., Scheimpflug tomography, optical coherence tomography (OCT) and the Corvis ST (Oculus, Wetzlar, Germany), including combined indices (e.g., BAD‑D, SCORE) and epithelium-based analyses, taking the current classification systems (ABCD, Amsler-Krumeich) into account.

Tomographic procedures enable detailed analysis of the anterior and posterior cornea as well as the pachymetric distribution. Biomechanical measurements complement the morphological assessment. Combined indices increase the sensitivity in the detection of subclinical cases. Nevertheless, diagnostic uncertainties remain in very early cases.

Modern multimodal diagnostics greatly improve the detection and follow-up of keratoconus; however, the diagnosis of subclinical forms remains challenging, highlighting the importance for frequent follow-up controls.