A Novel Zernike Application to Differentiate Between Three-dimensional Corneal Thickness of Normal Corneas and Corneas With Keratoconus

PurposeTo evaluate a novel Zernike algorithm to differentiate 3-dimensional (3-D) corneal thickness distribution of corneas with keratoconus (KC) from normal corneas.DesignA retrospective development and evaluation of a diagnostic approach.MethodsCorneal tomography with Scheimpflug imaging was performed in normal (43 eyes) and KC (85 eyes) corneas. Axial and tangential cone location magnitude index (axial CLMI and tangential CLMI, respectively) of the anterior and posterior surface were calculated. The aberrations of the anterior corneal surface were analyzed with Zernike polynomials. Pachymetric Zernike analyses (PZA) were used to map the 3-D thickness distribution of the cornea. Logistic regression was performed to develop a diagnostic procedure for KC using CLMI, PZA, and aberrations. A receiver operating characteristic curve was constructed for each regression model. Corneal volume was also compared between normal and KC corneas. Only the central 5 mm zone was used for all analyses.ResultsAmong the PZA coefficients, second- and third-order root mean squares of PZA coefficients were the best predictors of KC corneas (P < .0001). Among the CLMI variables, axial CLMI of anterior and tangential CLMI of posterior surface were the best predictors of KC (P < .0001). Among the Zernike corneal aberration coefficients, second- and third-order root mean squares of coefficients were the best predictors of KC (P < .0001). Sensitivity and specificity of Zernike corneal aberrations, CLMI, and PZA logistic regression model were similar (P > .05).ConclusionsThe entire 3-D corneal thickness was mapped with Zernike. The PZA method was comparable to CLMI and anterior corneal wavefront aberrations in detecting KC.