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Epithelial thickness offers insight into presence of corneal ectasia

Issue: November 25, 2011

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ORLANDO, Fla. — Epithelial thickness mapping may enhance the diagnosis of corneal ectasia, a clinician said here.

Dan Z. Reinstein, MD, elucidated study results of preoperative screening of refractive surgery candidates during Refractive Subspecialty Day preceding the American Academy of Ophthalmology meeting.

"You can't just judge keratoconus from the cover," Dr. Reinstein said. "We want a diagnostic technique that will distinguish a cornea on which we cannot do surgery and one on which we can do surgery."

The study included 1,532 eyes screened for ectasia and risk of keratoconus. Results showed that 136 eyes were deemed keratoconus suspect. Of those 136 eyes, 22 had an epithelial donut pattern that identified them as keratoconic. Artemis very high-frequency ultrasound (ArcScan Inc.) was used to obtain images of the epithelial surface.

Normal epithelial thickness profiles were seen in 114 eyes (84%); these eyes were deemed suitable candidates for refractive surgery. Subsequent post-LASIK follow-up data at 1 year and 2 years showed biomechanical stability and refractive outcomes comparable to those of a control group, Dr. Reinstein said.

• Disclosure:Dr. Reinstein is a consultant for Carl Zeiss Meditec and has a proprietary interest in the Artemis technology (ArcScan).

Dr. Reinstein brings up a very important finding in this presentation. The fact that the epithelium thickens around the base of the cone can hide findings on imaging of the anterior surface of the cornea. This is one reason why over the last several years we have become more dependent on the posterior surface analysis. Epithelial thickness mapping may also be helpful, with hopefully more new tools in the future to detect patients who may be at risk of progressive ectasia with either time or with surgery.

– David R. Hardten, MD
OSN Cornea/External Disease Section Editor
Disclosure: Dr. Harden has no relevant financial disclosures.