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Diagnosing Keratoconus Using VHF Digital Ultrasound Epithelial Thickness Profiles

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Keratoconus

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

There have been significant advances in keratoconus screening over the past decade largely due to enhanced analysis of corneal tomography; however, there remain some equivocal cases where a confident diagnosis cannot be made. Epithelial thickness mapping provides adjunctive diagnostic information that can help confirm or exclude keratoconus in suspicious cases. The epithelium has the ability to alter its thickness profile to re-establish a smooth, symmetrical optical outer corneal surface and either partially or totally mask stromal surface irregularities from front surface topography. In keratoconus, this manifests as epithelial thinning over the cone surrounded by an annulus of epithelial thickening, and increasing thinning and thickening with disease progression. In early keratoconus, this remodelling can be enough to completely mask the stromal surface cone, resulting in an apparently normal front surface topography. This can explain some reports of “ectasia without a cause”. In an eye with an eccentric back surface apex, a coincident epithelial doughnut pattern would confirm keratoconus, whereas the lack of localized epithelial thinning would exclude keratoconus. Very high-frequency digital ultrasound can provide maps of epithelial thickness for a 10 mm diameter, and OCT can do this for up to a 9 mm diameter. A number of groups are now working on developing automated algorithms to screen for keratoconus based on the epithelial thickness profile with encouraging results.

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Compliance with Ethical Requirements

Dr. Reinstein is a consultant for Carl Zeiss Meditec (Jena, Germany). Drs Reinstein and Silverman have a proprietary interest in the Artemis technology (ArcScan Inc., Golden, Colorado) and are authors of patents related to VHF digital ultrasound administered by the Center for Technology Licensing at Cornell University, Ithaca, New York. Timothy Archer, Marine Gobbe, and Raksha Urs declare that they have no conflict of interest.

Informed Consent: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

No animal studies were carried out by the authors for this chapter.

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Authors and Affiliations

  1. London Vision Clinic, London, UK

    Dan Z. Reinstein MD, MA(Cantab), FRCSC, FRC Ophth, Timothy J. Archer M.A.(Oxon), DipCompSci(Cantab) & Marine Gobbe M.S.T.(Optom), Ph.D.

  2. Columbia University Medical Center, New York, NY, USA

    Dan Z. Reinstein MD, MA(Cantab), FRCSC, FRC Ophth

  3. Centre Hospitalier National d’Ophtalmologie, Paris, France

    Dan Z. Reinstein MD, MA(Cantab), FRCSC, FRC Ophth

  4. School of Biomedical Sciences, University of Ulster, Coleraine, UK

    Dan Z. Reinstein MD, MA(Cantab), FRCSC, FRC Ophth

  5. Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA

    Raksha Urs Ph.D. & Ronald H. Silverman Ph.D.

  6. F.L. Lizzi Center for Biomedical Engineering, Riverside Research, New York, NY, USA

    Ronald H. Silverman Ph.D.

Authors
  1. Dan Z. Reinstein MD, MA(Cantab), FRCSC, FRC Ophth
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  2. Timothy J. Archer M.A.(Oxon), DipCompSci(Cantab)
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  3. Marine Gobbe M.S.T.(Optom), Ph.D.
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  4. Raksha Urs Ph.D.
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  5. Ronald H. Silverman Ph.D.
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Corresponding author

Correspondence to Dan Z. Reinstein MD, MA(Cantab), FRCSC, FRC Ophth .

Editor information

Editors and Affiliations

  1. Keratoconus Unit Department of Refractive Surgery, Vissum Alicante, Alicante, Spain

    Jorge L. Alió

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Reinstein, D.Z., Archer, T.J., Gobbe, M., Urs, R., Silverman, R.H. (2017). Diagnosing Keratoconus Using VHF Digital Ultrasound Epithelial Thickness Profiles. In: Alió, J. (eds) Keratoconus. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-43881-8_13

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  • DOI: https://doi.org/10.1007/978-3-319-43881-8_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43879-5

  • Online ISBN: 978-3-319-43881-8

  • eBook Packages: MedicineMedicine (R0)

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