Topographic, tomographic, and corneal wavefront asymmetry in keratoconus: towards an eye asymmetry index EASIX

Purpose The study aims to explore the intereye asymmetry in normal and keratoconic individuals and to evaluate the discriminant power of single and combined asymmetry parameters. Methods This is a retrospective designed study including 414 patients who had Pentacam Scheimpflug topographic and tomographic imaging in both eyes: 124 subjects with bilateral normal corneas evaluated for refractive surgery and 290 with keratoconus. All elevation-, pachymetric-, and volumetric-based data (56 parameters) were electronically retrieved and analyzed. Intereye asymmetry was determined by subtracting the lowest value from the highest value for each variable. The degree of asymmetry between each subject's eyes was calculated with intraclass correlation coefficients for all the parameters. Receiver operating characteristic curve was used to determine predictive accuracy and to identify optimal cutoffs of these values and combinations thereof. Results In the normal/keratoconus subjects the median intereye asymmetries were 0.30/3.45 for K2 (flat) meridian, 0.03/0.25 for BFS front, 1.00/15.00 for elevation back BFS apex, and 7.00/29.00 for pachy min. Conclusions In addition to Rabinowitz's K-max intereye asymmetry we propose pachymetric, elevation-based, and high-order corneal wavefront intereye asymmetry parameters to improve the diagnostic armamentarium of keratoconus.

Automated summary

The study aims to explore intereye asymmetry in normal and keratoconic individuals and proposes using asymmetry parameters to improve the diagnosis of keratoconus. The results show that in addition to existing parameters, thickness, elevation, and high-order corneal wavefront asymmetry parameters can be used for diagnosis.