International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 2 , ISSUE 3 ( September-December, 2013 ) > List of Articles


Evaluation of Visual Acuity, Pachymetry and Anterior-Surface Irregularity in Keratoconus and Crosslinking Intervention Follow-up in 737 Cases

Anastasios John Kanellopoulos, Vasiliki Moustou, George Asimellis

Citation Information : Kanellopoulos AJ, Moustou V, Asimellis G. Evaluation of Visual Acuity, Pachymetry and Anterior-Surface Irregularity in Keratoconus and Crosslinking Intervention Follow-up in 737 Cases. Int J Kerat Ect Cor Dis 2013; 2 (3):95-103.

DOI: 10.5005/jp-journals-10025-1060

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2013; The Author(s).



To investigate visual acuity, corneal pachymetry, and anterior-surface irregularity indices correlation with keratoconus severity in a very large pool of clinically-diagnosed untreated keratoconic eyes, and in keratoconic eyes subjected to crosslinking intervention.

Materials and methods

Total of 737 keratoconic (KCN) cases were evaluated. Group A was formed from 362 untreated keratoconic eyes, and group B from 375 keratoconic eyes subjected to partial normalization via topography-guided excimer laser ablation and high-fluence collagen crosslinking. A control group C of 145 healthy eyes was employed for comparison. We investigated distance visual acuity, uncorrected (UDVA), best-spectacle corrected (CDVA), and Scheimpflug-derived keratometry, pachymetry (central corneal thickness, CCT and thinnest, TCT), and two anterior-surface irregularity indices, the index of surface variance (ISV) and the index of height decentration (IHD). The correlations between these parameters vs topographic keratoconus classification (TKC) were investigated.


Keratometry for group A was K1 (flat) 46.67 ± 3.80 D and K2 (steep) 50.76 ± 5.02 D; for group B K1 44.03 ± 3.64 D and K2 46.87 ± 4.61 D; for group C, K1 42.89 ± 1.45 D and K2 44.18 ± 1.88 D. Visual acuity for group A was UDVA 0.12 ± 0.18 and CDVA 0.59 ± 0.25 (decimal), for group B, 0.51 ± 0.28 and 0.77 ± 0.22, and for group C, 0.81 ± 0.31 and 0.87 ± 0.12.

Correlation between ISV and TKC (r2) was for group A 0.853, and for group-B 0.886. Correlation between IHD and TKC was for group A r2 = 0.731, and for group B 0.701. The ROC analysis ‘area under the curve’ was for CDVA 0.550, TCT 0.596, ISV 0.876 and IHD 0.887.


Our study indicates that the traditionally employed metrics of visual acuity and corneal thickness may not be robust indicators nor provide accurate assessment on either keratoconus severity or postoperative evaluation. Two anterior surface irregularity indices, derived by Scheimpflug-imaging, ISV and IHD, may be more sensitive and specific tools.


Visual acuity, Scheimpflug-derived pachymetry and anterior-surface irregularity correlation to keratoconus severity in untreated cases (A), treated with crosslinking (B), and in a control group (C) reveals that visual acuity and pachymetry do not correlate well with keratoconus severity.

How to cite this article

Kanellopoulos AJ, Moustou V, Asimellis G. Evaluation of Visual Acuity, Pachymetry and Anterior-Surface Irregularity in Keratoconus and Crosslinking Intervention Follow-up in 737 Cases. J Kerat Ect Cor Dis 2013;2(3):95-103.

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