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      Assessing Progression of Keratoconus and Cross-linking Efficacy: The Belin ABCD Progression Display

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          Several methods have been described to both evaluate and document progression in keratoconus and to show efficacy of cross-linking, however, there are no consistent generally accepted parameters. Modern corneal tomography, including both anterior and posterior elevation and pachymetric data can be used to screen for ectatic progression, be employed to detect earlier change and additionally to show efficacy of new treatment modalities, such as crosslinking.

          To describe specific quantitative values that can be used as progression and efficacy determinants, the normal noise measurements of the three parameters used in the ABCD keratoconus classification (corneal thickness at the thinnest point, anterior and posterior radius of curvature taken from the 3.0 mm optical zone centered on the thinnest point), were determined. Values were obtained from both a normal population and a known keratoconic population. The 80 and 95% one-sided confidence intervals for all three parameters were surprisingly small, suggesting that they may perform well as progression and efficacy determinants.

          How to cite this article

          Belin MW, Meyer JJ, Duncan JK, Gelman R, Borgstrom M, Ambrósio Jr R. Assessing Progression of Keratoconus and Cross-linking Efficacy: The Belin ABCD Progression Display. Int J Kerat Ect Cor Dis 2017;6(1):1-10.

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          Most cited references53

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            Global consensus on keratoconus and ectatic diseases.

            Despite extensive knowledge regarding the diagnosis and management of keratoconus and ectatic corneal diseases, many controversies still exist. For that reason, there is a need for current guidelines for the diagnosis and management of these conditions. This project aimed to reach consensus of ophthalmology experts from around the world regarding keratoconus and ectatic diseases, focusing on their definition, concepts, clinical management, and surgical treatments. The Delphi method was followed with 3 questionnaire rounds and was complemented with a face-to-face meeting. Thirty-six panelists were involved and allocated to 1 of 3 panels: definition/diagnosis, nonsurgical management, or surgical treatment. The level of agreement considered for consensus was two thirds. Numerous agreements were generated in definitions, methods of diagnosing, and management of keratoconus and other ectatic diseases. Nonsurgical and surgical treatments for these conditions, including the use of corneal cross-linking and corneal transplantations, were presented in a stepwise approach. A flowchart describing a logical management sequence for keratoconus was created. This project resulted in definitions, statements, and recommendations for the diagnosis and management of keratoconus and other ectatic diseases. It also provides an insight into the current worldwide treatment of these conditions.
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              Keratoconus and related noninflammatory corneal thinning disorders

              Keratoconus and other noninflammatory corneal thinning disorders (keratoglobus, pellucid marginal degeneration and posterior keratoconus) are characterized by progressive corneal thinning, protrusion and scarring; the result is distorted and decreased vision. The etiology and pathogenesis of these disorders are unknown but may be associated with a variety of factors, including contact lens wear, eye rubbing, Down's syndrome, atopic disease, connective tissue disease, tapetoretinal degeneration and inheritance. Recent advances in techniques for biochemical and pathological investigation are now allowing further exploration in these areas. Early diagnosis is aided by the finding of irregular corneal astigmatism with inferior corneal steepening. Treatment ranges from simple spectacle correction to keratoplasty. In this review, the past and present literature on corneal thinning disorders is reviewed and practical approaches to diagnosis and management are outlined.

                Author and article information

                International Journal of Keratoconus and Ectatic Corneal Diseases
                Jaypee Brothers Medical Publishing
                July 24 2017
                June 2017
                : 6
                : 1
                : 1-10
                © 2017


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