International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 4 , ISSUE 2 ( May-August, 2015 ) > List of Articles


Errors Associated to Keratoconus Grading using Systems based on Corneal Power

Vicente Camps

Citation Information : Camps V. Errors Associated to Keratoconus Grading using Systems based on Corneal Power. Int J Kerat Ect Cor Dis 2015; 4 (2):41-46.

DOI: 10.5005/jp-journals-10025-1096

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2015; The Author(s).



To analyze and define the possible errors that may be introduced in keratoconus classification when the keratometric corneal power is used in such classification.

Materials and methods

Retrospective study including a total of 44 keratoconus eyes. A comprehensive ophthalmologic examination was performed in all cases, which included a corneal analysis with the Pentacam system (Oculus). Classical keratometric corneal power (Pk), Gaussian corneal power (PcGauss), True Net Power (TNP) (Gaussian power neglecting the corneal thickness effect), and an adjusted keratometric corneal power (Pkadj) (keratometric power considering a variable keratometric index) were calculated. All cases included in the study were classified according to five different classification systems: Alió-Shabayek, Amsler-Krumeich, Rabinowitz- McDonnell, collaborative longitudinal evaluation of keratoconus (CLEK), and McMahon.


When Pk and Pkadj were compared, differences in the type of grading of keratoconus cases was found in 13.6% of eyes when the Alió-Shabayek or the Amsler-Krumeich systems were used. Likewise, grading differences were observed in 22.7% of eyes with the Rabinowitz-McDonnell and McMahon classification systems and in 31.8% of eyes with the CLEK classification system. All reclassified cases using Pkadj were done in a less severe stage, indicating that the use of Pk may lead to the classification of a cornea as keratoconus, being normal. In general, the results obtained using Pkadj, PcGauss or the TNP were equivalent. Differences between Pkadj and PcGauss were within ± 0.7D.


The use of classical keratometric corneal power may lead to incorrect grading of the severity of keratoconus, with a trend to a more severe grading.

How to cite this article

Llorens DPP, Camps V, Caravaca-Arens E. Errors Associated to Keratoconus Grading using Systems based on Corneal Power. Int J Kerat Ect Cor Dis 2015;4(2):41-46.

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