Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift
Abstract Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, m...
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | Eye and Vision |
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| Online Access: | https://doi.org/10.1186/s40662-023-00363-0 |
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| author | Renato Ambrósio Marcella Q. Salomão Lorena Barros João Batista R. da Fonseca Filho Jaime Guedes Alexandre Neto Aydano P. Machado Bernardo T. Lopes Nelson Sena Louise Pellegrino Gomes Esporcatte |
| author_facet | Renato Ambrósio Marcella Q. Salomão Lorena Barros João Batista R. da Fonseca Filho Jaime Guedes Alexandre Neto Aydano P. Machado Bernardo T. Lopes Nelson Sena Louise Pellegrino Gomes Esporcatte |
| author_sort | Renato Ambrósio |
| collection | DOAJ |
| description | Abstract Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea. |
| first_indexed | 2024-03-11T12:43:30Z |
| format | Article |
| id | doaj.art-33215c26338a478da2bc6ee75719458f |
| institution | Directory Open Access Journal |
| issn | 2326-0254 |
| language | English |
| last_indexed | 2024-03-11T12:43:30Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Eye and Vision |
| spelling | doaj.art-33215c26338a478da2bc6ee75719458f2023-11-05T12:08:06ZengBMCEye and Vision2326-02542023-11-0110112610.1186/s40662-023-00363-0Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shiftRenato Ambrósio0Marcella Q. Salomão1Lorena Barros2João Batista R. da Fonseca Filho3Jaime Guedes4Alexandre Neto5Aydano P. Machado6Bernardo T. Lopes7Nelson Sena8Louise Pellegrino Gomes Esporcatte9Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO)Department of Ophthalmology, Federal University of São PauloDepartment of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO)Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO)Rio de Janeiro Corneal Tomography and Biomechanics Study GroupDepartment of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO)Department of Ophthalmology, Federal University of São PauloRio de Janeiro Corneal Tomography and Biomechanics Study GroupDepartment of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO)Department of Ophthalmology, Federal University of São PauloAbstract Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.https://doi.org/10.1186/s40662-023-00363-0KeratoconusCorneal ectasiaSusceptibilityMultimodal corneal imagingCorneal biomechanicsCorneal tomography |
| spellingShingle | Renato Ambrósio Marcella Q. Salomão Lorena Barros João Batista R. da Fonseca Filho Jaime Guedes Alexandre Neto Aydano P. Machado Bernardo T. Lopes Nelson Sena Louise Pellegrino Gomes Esporcatte Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift Eye and Vision Keratoconus Corneal ectasia Susceptibility Multimodal corneal imaging Corneal biomechanics Corneal tomography |
| title | Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift |
| title_full | Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift |
| title_fullStr | Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift |
| title_full_unstemmed | Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift |
| title_short | Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift |
| title_sort | multimodal diagnostics for keratoconus and ectatic corneal diseases a paradigm shift |
| topic | Keratoconus Corneal ectasia Susceptibility Multimodal corneal imaging Corneal biomechanics Corneal tomography |
| url | https://doi.org/10.1186/s40662-023-00363-0 |
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