Objective and Subjective Diagnostic Parameters in the Fellow Eye of Unilateral Keratoconus
Objective and Subjective Diagnostic Parameters in the Fellow Eye of Unilateral Keratoconus
patients with keratoconus in one eye and forme fruste keratoconus in the fellow eye compared
 to normal subjects .the patients were examined by schemipflug imaging system (Pentacam)
This cross-sectional study was carried out on patients presenting keratoconus in one eye and
 forme fruste keratoconus in the fellow eye; the patients attended the outpatient clinic of
 Mansoura ophthalmic center between January 2014 and February 2015. This study was approved by
 the institutional research board of the Mansoura faculty of medicine and was performed in
 accordance with the ethical standards of the Declaration of Helsinki. All patients included
 in the study provided informed consent.

 Ocular examinations were performed on all eyes included in the study. Clinical Keratoconus
 was diagnosed if all the following criteria were found:1)asymmetric bow tie with skewed
 radial axis (SRAX), inferior or central steepening on the topography map, 2)mean keratometry
 (K)>47diopters or an inferior-superior (I-S) value >1.4diopters according to the Rabinowitz
 and McDonnell criteria[8],and 3)at least one clinical symptom(i.e., stromal thinning, conical
 protrusion of corneal apex,Fleischer ring, Vogt striae or anterior stromal scar). Forme
 fruste keratoconus was diagnosed if all the following criteria were found: 1) normal
 topography, 2) mean K<47D and I-S ≤1.4,3) normal slit lamp, and 4)keratoconus in the fellow
 eye.

 The eyes with an evident keratoconus diagnosis were included in (Group A)and the fellow eyes
 were included in (Group B).Control cases(Group C) were selected from the normal database of
 candidates for refractive surgery with the following:1)normal topography, 2)negative rotating
 Scheimpflug device indices and negative topographic keratoconus classification, 3)normal slit
 lamp examination, and 4)no history of eye disease(only one eye of each normal candidate was
 included in the study depending on a computer-based randomizing program).

 The exclusion criteria included previous ocular surgery or trauma, significant corneal
 scarring or associated ocular pathology.

 All eyes were examined by rotating Scheimpflug corneal tomography (Pentacam, Oculus
 Optikgerate GmbH).No patients in the study wore contact lenses. During the Scheimpflug
 corneal tomography examination, the patient was properly positioned on the chin rest and
 forehead strap. The patient was asked to blink several times then open both eyes and stare at
 a fixed target. After obtaining proper alignment, the automatic release mode started the
 scan; a total of25 single Scheimpflug images were captured within 2 sec for each eye. Three
 consecutive scans were taken of each eye by the same examiner. The average of the results of
 three acceptable measurements was included in the study. Each eye was required to have a
 corneal map with at least 9 mm of corneal coverage and no extrapolated data.

 The Pentacam maps were analyzed. The following anterior and posterior corneal surface
 parameters were evaluated by the Scheimpflug system: corneal dioptric power at the flattest
 meridian in the 3 mm-central zone(K1),corneal dioptric power in the steepest meridian in the
 3mm-central zone (K2)and mean corneal power in the 3mm-zone (mean K).

 The pachymetric map was analyzed, including the central corneal thickness (CCT) at the apex
 of the geometric center and corneal thickness at the thinnest point (CTmin).The average
 progression index (PPI avg) was calculated as the progression value at the different rings
 referenced to the mean curve. The minimum (PPI min) and maximum (PPI max) progression indices
 were recorded. The Ambrósior elational thickness (ART)was calculated as follows:
 ARTavg=CTmin/PPIavg,ARTmin = CTmin/PPImin, ARTmax =CTmin/PPImax[9].

 The posterior corneal elevation maps were evaluated; a reference best fit sphere was
 calculated at a fixed optical zone of 8 mm, and the posterior corneal elevation values
 relative to this reference were recorded. The back difference elevation and multimetric D
 index values were extrapolated from the difference map of the Belin/Ambrósio-enhanced ectasia
 display of the Pentacam system.

 Contrast and Glare sensitivity test:

 The contract and glare tests were carried out with a Mesotest II (Oculus Optikgeräte GmbH,
 Wetzlar, Germany), which consists of Landolt rings of different contrast levels presented in
 front of a low-brightness background. There are 4 contrast levels, 1:23, 1:5, 1:2.7, and 1:2,
 which represent the ratio between the light intensity of the optotypes and the background.
 There were 8 tests, 4 without glare and 4 with glare. Test 1, with a contrast level of 1:23,
 is the most easily recognized. For statistical purposes, each level of the contrast or glare
 test was given a score ranging from 20% at the 1:23 level to 100% at the 1:2 level.
Inclusion Criteria:

 -  patients with clinically evident keratoconus in one eye and apparently normal in the
 fellow eye

 Exclusion Criteria:

 -  previous ocular surgery or truama,significant corneal scarring or associatedocular
 pathology