Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics

PURPOSE: To evaluate the clinical features of keratoconus taking into consideration anterior corneal aberrations, internal astigmatism, and corneal bionnechanical properties and to define a new grading system based on visual limitation. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Retrospective case series. METHODS: This multicenter study comprised consecutive keratoconic eyes with no previous ocular surgery or active ocular disease. Visual, refractive, corneal topography, and pachymetry outcomes were analyzed. Internal astigmatism was calculated by vectorial analysis. Corneal aberrations and corneal biomechanics characterized by the Ocular Response Analyzer were evaluated in some eyes. Correlations between clinical data and a linear multiple regression analysis for characterizing the relationship between visual limitation and objective clinical data were performed. RESULTS: This study comprised 776 eyes of 507 patients (age range 11 to 79 years) The mean keratometry (K) correlated significantly with logMAR corrected distance visual acuity (CDVA) (r = 0.591, P<.01), internal astigmatism (r = 0.497, P<.01), corneal asphericity (r = -0.647, P<.01), and several corneal higher-order aberrometric coefficients (r >= 0.603, P<.01). Significant correlations were found between some corneal aberrometric parameters and CDVA (r >= 0.444, P<.01). Multiple regression analysis showed that CDVA was significantly correlated with the mean K, intraocular pressure, corneal resistance factor, and spherical equivalent (r(2) = 0.69, P<.01). There were significant differences in mean K, internal astigmatism, and corneal higher-order aberrations between 4 groups differentiated by visual limitation (P<.01). CONCLUSION: The visual limitation in keratoconus could be explained by different alterations that occur in these corneas and allowed development of a new grading system for this condition.