Correlation of Corneal and Scleral Topography in Cases with Ectasias and Normal Corneas

Background and Objective To determine the relationships between corneal and scleral elevation topography in subjects with corneal ectasias and normal corneas.   Material and Methods This is a multi-site retrospective study. Ocular surface topography (sMap3D, Precision Ocular Metrology, US) was collected on 115 eyes with prolate cornea profile (Group A) and 227 eyes showing corneal ectasia (Group B). Sagittal height (SAG 1) was measured in the axis of the highest elevated point of the cornea (apex), defined by the meridian joining this apex to the geometrical center of the cornea at an 16 mm chord diameter (8-mm radius). Another sag value was evaluated 180° away (SAG 2) at the same diameter/radius. The difference in height between SAG 1 and SAG 2 represents a quadrant specific effect (QSE). Conjunctival toricity is estimated by comparing the best fit of the conjunctival/scleral shape data to a toric (Sin2) curve; the root- mean-squared error (RMSE) of this curve, a measure of irregularity, was also calculated.   Results The ectasia subjects demonstrated greater QSE, (p<0.001), standard toricity (p<0.001) and RMSE (p<0.001) on the sclera compared to normal cornea cases. If the apex of the ectasia was ≥1.25mm from the corneal center, the asymmetry was greater. Within the Group A, standard toricity was significantly higher than QSE (p<0.001) suggesting a more regular conjunctival pattern. As a proof, a significantly greater proportion of cases in Group B vs. Group A (57% vs. 26%, p<0.001) were found with conjunctival irregular shape, as previously defined. In both groups, subjects graded as having spherical/toric scleral shape had significantly lower RMSE values than those graded as having irregular shapes (p<0.001).   Conclusion Subjects with corneal ectasia have a different scleral shape compared to those with normal corneal profiles, largely presenting as a quadrant specific effect along the same axis. This difference is higher if the apex of the ectasia is ≥1.25 mm from the corneal center. RMSE seems to correlate with scleral shape classification in both groups.