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The Role of Ocular Response Analyzer in Differentiation of Forme Fruste Keratoconus From Corneal Astigmatism

Kirgiz, Ahmet, M.D.; Karaman Erdur, Sevil, M.D.; Atalay, Kursat, M.D.; Gurez, Ceren, M.D.

doi: 10.1097/ICL.0000000000000541

Purpose: To determine the diagnostic accuracy of corneal biomechanical factors in differentiating patients with forme fruste keratoconus (FFKC) from astigmatic and normal cases.

Methods: A total of 50 eyes with FFKC, 50 with astigmatism and 50 normal eyes, were included in this study. All patients had a detailed ophthalmologic examination including slit-lamp evaluation, Goldmann tonometry, indirect fundoscopy, topography by Scheimpflug imaging biomicroscopic anterior and posterior segment examination, and corneal biomechanical and intraocular pressure evaluation with ocular response analyzer (ORA).

Results: All topographic findings were statistically significant among the three groups (P>0.05). Although there was no statistically significant difference in the corneal-compensated intraocular pressure (IOPcc) among the three groups, the Goldmann-correlated intraocular pressure (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were statistically significantly lower in the FFKC group, compared with the other groups (P<0.001). There were no statistically significant difference in the IOPg, CH, and CRF between astigmatism and control groups (P=0.99, 0.79, and 0.86, respectively). The area under the receiver operating characteristic (AUROC) curve was greater than 0.85 for IOPg (0.80), CH (0.85), and CRF (0.90) for discriminating between FFKC and controls; whereas the AUROC was greater than 0.85 for IOPg (0.80), CH (0.79), and CRF (0.85) for discriminating between FFKC and astigmatism groups.

Conclusion: Based on our study results, in differentiation of patients with FFKC from normal control cases or astigmatic patients, corneal biomechanical parameters play a role particularly in patients with suspicious results. We suggest using ORA in combination with corneal topography for better and more accurate diagnosis of FFKC.

Department of Ophthalmology (A.K., K.A., C.G.), Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; and Department of Ophthalmology (S.K.E.), Istanbul Medipol University, Istanbul, Turkey.

Address correspondence to Sevil Karaman Erdur, M.D., Department of Ophthalmology, Istanbul Medipol University, Istanbul, Turkey; e-mail:

The authors have no funding or conflicts of interest to disclose.

Accepted July 01, 2018

© 2019 Contact Lens Association of Ophthalmologists, Inc.