Screening for Keratoconus With New Dynamic Biomechanical In Vivo Scheimpflug Analyses

Purpose: To improve keratoconus (KC) screening with new in vivo biomechanical Scheimpflug analyses. Methods: After adjusting for intraocular pressure and corneal thickness, predefined static and new dynamic Scheimpflug curve analyses [Pentacam HR and Corvis ST (CST); Oculus] of 87 normal eyes, 27 subclinical KC eyes, 42 suspected KC, and 65 manifest KC eyes were reviewed retrospectively. A t test (for a normal distribution), Wilcoxon matched-pairs test (if not normally distributed), and receiver operating characteristics were used to test for statistically significant differences between these groups. In addition, new dynamic curve analyses were performed to analyze corneal dynamics throughout the entire response to the CST air puff impulse. Results: Comparing normal and KC-suspect eyes, the parameters A1 length, A2 length, radius of the inward-bended cornea, and deflection length at the highest concavity revealed statistically significant differences. In addition, the newly calculated “applanation length level” and “deflection length level” demonstrated consistently increasing differences with increasing statistical significance between normal eyes and those with advancing KC stages. However, when comparing normal and subclinical KC eyes, none of the analyzed parameters demonstrated statistically significant differences. Conclusions: In vivo biomechanical analyses (CST) at their current state only marginally improve KC screening protocols. Newly generated parameters such as the applanation length level and deflection length level might further improve early KC screening.