A coincident thinning index for keratoconus identification using OCT pachymetry and epithelial thickness maps

PURPOSE: To develop a coincident thinning (CTN) index to differentiate between keratoconic and healthy corneas using optical coherence tomography (OCT) measurements of pachymetry and epithelial thickness. METHODS: Pattern deviation maps of pachymetry and epithelial thickness were generated using Fourier-domain OCT images of the cornea. The co-localized thinning of the two maps was quantified using a novel CTN index, which was calculated from Gaussian fits of the regions of maximum relative thinning. The CTN index was validated using k-fold cross-validation, and its classification performance was compared to minimum pachymetry and maximum keratometry. RESULTS: A total of 82 normal eyes and 133 eyes within three groups of keratoconus severity were evaluated. The pattern deviation maps for the keratoconic eyes showed relative thinning that was larger in magnitude and more strongly correlated with the Gaussian function compared to normal eyes (all P < .01). The distance between the pachymetric and epithelial maximum relative thinning locations was significantly smaller for the keratoconic eyes than for the normal eyes (all P < .02). The CTN index was significantly larger for all three keratoconus groups compared to normal eyes (all P < .0001). The CTN index demonstrated a sensitivity of 100% in detecting manifest keratoconus, 100% for subclinical keratoconus, and 56% for forme fruste keratoconus. The overall classification accuracy was better for the CTN index (93%) than for minimum pachymetry (86%) and maximum keratometry (86%). CONCLUSIONS: The CTN index is a highly sensitive measure of coincident pachymetric and epithelial thinning. It provides valuable information for detecting and monitoring early to moderate keratoconus.