Differentiating contact lens induced warpage from true keratoconus using corneal topography

Purpose: Superior corneal flattening associated with inferior corneal steepening is a videokeratoscopic topography pattern that usually describes both keratoconus and contact lens induced warpage. To differentiate these two conditions topographically, we analyzed ten different corneal topographic shape variables and found that two distinct conditions were described. Three unique measurements of corneal geometry: shape factor (SF), irregularity (CIM), and apical toricity (TKM) were analyzed and evaluated as an additional method for differentiating these two conditions. Methods: A retrospective series of 100 eyes with a medical diagnosis of either contact lens induced warpage or true keratoconus were mapped using the Humphrey Atlas(TM) Corneal Topographer (San Leandro, CA) and their individual topographic indices were analyzed in an attempt differentiate the two conditions with videokeratoscopy. Variables included Flat Keratometry Reading, Maximum Axial Curvature, Maximum Tangential Curvature, Corneal Astigmatism, Corneal Shape Factor, Reference Sphere, Corneal Irregularity Measure (CIM), Maximum Elevation, and Mean Reference Toric K (TKM). All patients wore rigid gas permeable contact lenses. Results: True keratoconic eyes had steeper flat K readings (46.9±3.7 D vs. 43.04±1.18 D; P<6.3E-13) with greater variations in maximum axial curvature (54.1±4.76 D vs. 43.6±1.5 D; P<2.4E-15) and maximum tangential curvature (55.17±4.56 D vs. 47.7±1.5 D; P<5.4E-16) than did eyes with contact lens induced warpage. The amount of corneal toricity (- 3.43±2.29 D vs. -1.33±0.88 D; P<1.5E-07) was also greater for true keratoconus. True keratoconic eyes had larger and more variable shape factors (0.61±0.26 vs. 0.02±0.13; P<2.5E-19) and CIM's (2.30±1.16 vs. 1.03±0.37; P<7.5E-10) than those with contact lens induced warpage. Steeper reference spheres (47.58±3.55 D vs. 43.6±0.37 D; P<2.2E-10), greater maximum elevation over their respective reference spheres (15.51±9.91μ vs. 6.2±3.0μ; P<8.1E-08) and steeper, more variable toric mean reference spheres (51.88±4.01 D vs. 43.82±1.82 D; P<3.9E-17) are also present in true keratoconus. True keratoconic eyes can be separated from contact lens induced warpage eyes with a sensitivity of 98%, while identification of contact lens induced warpage demonstrates 94% specificity using corneal topography. Conclusions: While contact lens induced warpage and true keratoconus exhibit similar corneal topography patterns (superior flattening and inferior steepening), they demonstrate two uniquely different geometric shapes that can be readily differentiated using the various corneal shape indices of videokeratoscopy with a high degree of accuracy and specificity.