Quantitative evaluation of the natural progression of keratoconus using three-dimensional optical coherence tomography

PURPOSE. We quantified the chronologic progression of keratoconus using anterior segment optical coherence tomography (AS-OCT). METHODS. A total of 217 eyes from 113 patients with keratoconus, keratoconus suspect, or forme fruste keratoconus were evaluated by corneal tomography using swept-source OCT. Age-dependent changes in the radius of the posterior best-fit sphere (R_post), minimum corneal thickness (T_min), and distance from the thinnest point to the corneal vertex (D_min) were examined over follow-up periods of up to 5.79 years and were analyzed using generalized estimating equation (GEE) nonlinear regression model. RESULTS. Annual changes in R_post (mean, -0.017 mm) and T_min (-2.69 μm) were significantly higher in younger patients (P < 0.01, GEE nonlinear regression) and in patients with higher maximal K value (K_max; P < 0.01, GEE nonlinear regression), whereas no changes were observed in Dmin. Even in patients 30 years or older, 14% of eyes revealed remarkable progression in R_post. In eyes with acute hydrops, annual changes in R_post (-0.22 mm) and T_min (-33.8 μm) before acute corneal hydrops were more than 10 times faster than those in other eyes (P < 0.001, GEE nonlinear regression). CONCLUSIONS. Chronologic measurements of corneal tomography in keratoconus demonstrated that the progression of steepening at posterior corneal surface was found not only in patients under 30 years but also in older patients, particularly in advanced keratoconus. The rate of progression can be measured by mapping of corneal curvature and thickness using OCT, and the risk of progression was greater in younger patients with steeper K_max.