Non-central keratoconus has lesser effect on SimK, pachymetry and smaller-aperture HOARMS. Using 'SimK steep >47.2 D or CCT < 491.6 μ' may miss timely referral for topography in many of these cases. Using more stringent criteria of SimK steep K ≥ 45.8 D or CCT ≤ 503 μ to get a corneal topography done to rule out keratoconus is recommended, especially in cohorts with higher risk.
The purpose of this study is to analyze the repeatability and agreement of corneal power using a new Hartman type topographer in comparison to Scheimpflug+Placido and autorefractor devices. In this cross sectional, observational study performed at the cornea services of a specialty hospital, 100 normal eyes (100 consecutive candidates) without any previous ocular surgery or morbidity except refractive error were evaluated. All candidates underwent three measurements each on a Full gradient, Hartman type topographer (FG) (iDesign, AMO), Scheimpflug+Placido topographer (SP) (Sirius, CSO) and rotating prism auto-keratorefractor (AR) (KR1, Nidek). The parameters assessed were flat keratometry (K1), steep keratometry (K2), steep axis (K2 axis), mean K, J 0 and J 45. Intra-device repeatability and inter-device agreement were evaluated. On repeatability analysis, the intra-device means were not significantly different (ANOVA, p > 0.05). Intraclass correlations (ICC) were >0.98 except for J 0 and J 45. In terms of intra-measurement standard deviation (Sw), the SP and FG groups fared better than AR group (p < 0.001, ANOVA). On Sw versus Average plots, no significantly predictive fit was seen (p > 0.05, R (2) < 0.1 for all the values). On inter-device agreement analysis, there was no difference in means (ANOVA, p > 0.05). ICC ranged from 0.92 to 0.99 (p < 0.001). Regression fits on Bland-Altman plots suggested no clinically significant effect of average values over difference in means. The repeatability of Hartman type topographer in normal eyes is comparable to SP combination device and better than AR. The agreement between the three devices is good. However, we recommend against interchanging these devices between follow-ups or pooling their data.
Normal eyes of Arab ethnicity tend to have statistically thicker and flatter corneas and less-crowded anterior segments than those of the South Asian counterparts. These epidemiological differences have a mild to moderate biological effect size (Cohen d), but they should be considered when evaluating these eyes for anterior segment or corneal procedures.
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