Abstract
Purpose :
Scheimpflug technology like Pentacam is useful to diagnose and monitor keratoconus (KC) and forme fruste keratoconus (FFKC), but it is not well understood as a screening tool in children and adolescents who typically have more severe and aggressive disease. Early detection in this age group is critical for prompt intervention to slow disease progression. This retrospective clinical study aims to evaluate what factors increase the probability of finding abnormalities on initial Pentacam images taken in pediatric patients undergoing screening for KC.
Methods :
A retrospective review of patients ages 3-22 years who underwent Pentacam imaging to screen for KC from 2021-23 was completed. Eighty eyes of 80 patients were evaluated with slit-lamp and Pentacam. Each patient’s final D, ART max, and calculated CAIRO 8 index were compared to pediatric ranges for normal and FFKC/KC corneas, and values in between were considered indeterminate. Statistical analyses were performed using ANOVA and Chi-square, and p-values < 0.05 were considered significant.
Results :
Most patients were screened due to high and/or progressive astigmatism (74 patients, 93%). Forty-nine patients (61%) were Hispanic, 50 (63%) male, and 15 (19%) had abnormal corneal findings like thinning and protrusion; average astigmatism was 5.04 ± 1.09 D and age was 12.05 ± 4.11 years (Table 1). Twenty-four patients (30%) had normal values and 11 patients (14%) were in FFKC/KC range for all 3 indices (final D, ART max and CAIRO 8). Eyes divided into the FFKC/KC group based on all parameters were significantly older than normal and indeterminate corneas (p=0.006) by an average of 4 years and more likely to have abnormal corneal findings (p<0.00001) (Table 2). Race, ethnicity, astigmatism, and gender did not vary significantly for any of the stratified indices (except for final D value in Hispanic patients, p=0.0495).
Conclusions :
In screening for pediatric KC, older age and corneal findings increase the probability of abnormalities on initial Pentacam. Of those with a clinical suspicion for keratoconus (usually high and/or progressive astigmatism), 70% had at least one abnormal or indeterminate value. Long-term follow-up will determine how many of these patients will progress.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.