Corneal Vertical and Horizontal Thickness Profiles Generated by UHR-OCT for Suspected and Subclinical Keratoconus Diagnosis

PURPOSE: To verify the diagnostic power of vertical and horizontal thickness profiles of the corneal sublayers generated by ultra-high resolution optical coherence tomography (UHROCT) in subclinical and suspected keratoconus. METHODS: In this cross-sectional study, 25 eyes with confirmed keratoconus, 63 eyes with suspected keratoconus, 15 eyes with subclinical keratoconus, and 42 normal eyes were investigated. Vertical and horizontal thickness profiles of the corneal epithelium, Bowman's layer, and stroma were measured by UHR-OCT. Diagnostic indices included ratios of thickness distribution and multimeric discriminant functions calculated by multiple logistic regression based on them. Receiver operating characteristic curves were used to verify the predictive accuracy by the area under the curve (AUC). RESULTS: Function consisting of two indices (vertical maximum ectasia index of epithelium and horizontal maximum ectasia index of Bowman's layer) performed well to discriminate subclinical keratoconus (AUC = 0.967) and suspected keratoconus (AUC = 0.932) from normal. In addition, when four indices were combined, the diagnostic power for subclinical keratoconus (AUC = 0.984) and suspected keratoconus (AUC = 0.971) was further increased. However, both binary and quaternary functions could not adequately discriminate suspected from subclinical keratoconus. CONCLUSIONS: UHR-OCT–generated thickness indices from the vertical and horizontal thickness profiles of the corneal epithelium and Bowman's layer showed an evident diagnostic efficacy in discriminating suspected and subclinical keratoconus from normal eyes. The early changes in keratoconus might prefer thickness distribution in corneal sublayers rather than corneal thickness or topography. [ J Refract Surg . 2021;37(7):438–445.]