International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 4 , ISSUE 3 ( September-December, 2015 ) > List of Articles


A new Tomographic Method of Staging/Classifying Keratoconus: The ABCD Grading System

Josh Duncan, José AP Gomes

Citation Information : Duncan J, Gomes JA. A new Tomographic Method of Staging/Classifying Keratoconus: The ABCD Grading System. Int J Kerat Ect Cor Dis 2015; 4 (3):85-93.

DOI: 10.5005/jp-journals-10025-1105

Published Online: 01-12-2017

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



To incorporate advanced corneal imaging into a new keratoconus classification system that utilizes posterior curvature, thinnest pachymetry, and best-corrected distance vision (CDVA) in addition to standard anterior parameters.

Materials and methods

A total of 672 eyes of 336 normal patients were imaged with the Oculus Pentacam HR. Anterior and posterior radius of curvature measurements were taken using a 3.0 mm zone centered on the thinnest area and corneal thickness was measured at the thinnest point. Mean and standard deviations were recorded and anterior data were compared to the existing Amsler-Krumeich (AK) classification.


A total of 672 eyes of 336 patients were analyzed. Anterior and posterior values were 7.65 ± 0.236 mm / 6.26 ± 0.214 mm respectively and thinnest pachymetry values were 534.2 ± 30.36 um. Comparing anterior curvature values to AK staging yielded 2.63, 5.47, 6.44 standard deviations for stages 1, 2, and 3 respectively. Posterior staging uses the same standard deviation gates. Comparative pachymetric values yielded 4.42, and 7.72 standard deviations for stages 2 and 3 respectively.


A new keratoconus staging system incorporates posterior curvature, thinnest pachymetric values, and distance visual acuity in addition to the standard anterior curvature and consists of stages 0 to 4 (5 stages), closely matches the existing AK classification stages 1 to 4 on anterior curvature. The new classification system by incorporating curvature and thickness measurements based on the thinnest point, as opposed to apical, better reflects the anatomic changes in keratoconus.

How to cite this article

Belin MW, Duncan J, Ambrósio R Jr, Gomes JAP. A New Tomographic Method of Staging/Classifying Keratoconus: The ABCD Grading System. Int J Kerat Ect Cor Dis 2015;4(3):85-93.

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