Assessing ectasia susceptibility prior to LASIK: the role of age and residual stromal bed (RSB) in conjunction to Belin-Ambrósio deviation index (BAD-D)

Ambrósio, Renato; Ramos, Isaac; Lopes, Bernardo; Canedo, Ana Laura; Correa, Rosane; Guerra, Frederico P.; Luz, Allan; Price, Francis W.; Price, Marianne O.; Schallhor, Steven; Belin, Michael W.

doi:10.5935/0034-7280.20140018

Cited by 40 publications

(33 citation statements)

References 23 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cut-off of 0.068 (6.8% of relative risk) provided 100% sensitivity and 94% specificity, with better area under the receiver operating characteristic curve (AUC=0.989; 95% CI: 0.969 to 0.998) than all parameters, including the BAD-D (AUC=0.931; CI: 0.895 to 0.957; De Long, p > 0.001). 30 Thereby, the ESS-I enables the calcula- …”

Section: Enhanced Screening For Ectasia Susceptibilitymentioning

confidence: 99%

“…The ectasia susceptibility score (ESS-I) was created based on the preoperative clinical and corneal tomography data from 23 cases that developed ectasia after LASIK and from 266 stable LASIK with over 1 year of follow-up. 30 The regression formula combining BAD-D, age, and RSB was calculated. The cut-off of 0.068 (6.8% of relative risk) provided 100% sensitivity and 94% specificity, with better area under the receiver operating characteristic curve (AUC=0.989; 95% CI: 0.969 to 0.998) than all parameters, including the BAD-D (AUC=0.931; CI: 0.895 to 0.957; De Long, p > 0.001).…”

Section: Enhanced Screening For Ectasia Susceptibilitymentioning

confidence: 99%

“…While this may be a challenging and complex task for the clinician to combine the data from different sources, artificial intelligence techniques, such as neural network (NN), decision tree (DT), support vector machine (SVM), and regression analysis have been used to facilitate clinical decisions. 8,18,24,27,30 In a retrospective case control study, 177 normal eyes were compared to 148 eyes with clinical keratoconus and to 47 eyes with normal topography from 47 patients with clinical keratoconus in the fellow eye using the Galilei. A total of 55 parameters were analyzed so that a machine learning algorithm was created using a DT approach.…”

Section: Enhanced Screening For Ectasia Susceptibilitymentioning

confidence: 99%

“…20 Interestingly, in a retrospective nonrandomized study involving preoperative LASIK data from an international pool comprising of 23 post-LASIK ectasia cases and from 266 stable-LASIK with over one year of follow-up, the criteria of BAD-D higher than 1.29 provided 87% of sensitivity and 92.1% of specificity. 30 Even though, the BAD-D was the most accurate parameter in predicting ectasia risk, the data suggests room for further improvement.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Enhanced Screening for Ectasia Risk prior to Laser Vision Correction

Belin¹,

Ambrósio²

2017

International Journal of Keratoconus and Ectatic Corneal Diseases

View full text Add to dashboard Cite

Aim: To prospectively review current understanding and future trends of screening for keratectasia risk prior refractive laser vision correction (LVC).Background: Progressive keratectasia is an uncommon but severe complication of LVC. Preoperative ectatic corneal disease is the most important risk factor. Screening for subclinical ectasia relies on proper interpretation of advanced diagnostic technologies, including front surface corneal topography, three-dimensional tomography, and biomechanical assessments.Summary: Studies involving eyes with normal and stable corneas, compared to eyes with frank ectatic diseases and to eyes with normal topography from patients with very asymmetric ectasia, allow for developing advanced methods and testing its sensitivity. However, the ideal study populations for testing the sensitivity and specificity of ectasia risk assessments are respectively the preoperative of cases that developed ectasia and the ones with stable outcomes after LVC. Young age and low thickness are surrogates of corneal biomechanics, which may be replaced as risk factors by direct measurements. Keratectasia may also occur due to the surgical impact on corneal structure or due to significant trauma postoperatively. Percentage tissue altered higher than 40% is a more sensitive para meter than a fixed value for minimal residual stromal bed of 250 µm. However, the biomechanical impact from surgery is related to the region and number of lamellae that are severed, so that flap thickness and geometry should play a more relevant role, which is in agreement with finite element simulations. Arti ficial intelligence methods allow for combining parameters, which significantly enhance the accuracy for detecting ectasia risk. Conclusion:An enhanced screening approach for preventing keratectasia should consider both preoperative patient-related data and procedure-related parameters to individually characterize ectasia susceptibility or predisposition.Clinical Significance: Keratectasia is an uncommon, however, severe complication of LVC. Although prevention is the best strategy, an individualized enhanced ectasia screening approach for ectasia risk assessment prior to LVC procedures should integrate patient-related (individual ectasia susceptibility) and procedure-related parameters (biomechanical impact).

show abstract

Section: Enhanced Screening For Ectasia Susceptibilitymentioning

confidence: 99%

Section: Enhanced Screening For Ectasia Susceptibilitymentioning

confidence: 99%

Section: Enhanced Screening For Ectasia Susceptibilitymentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Enhanced Screening for Ectasia Risk prior to Laser Vision Correction

Belin¹,

Ambrósio²

2017

International Journal of Keratoconus and Ectatic Corneal Diseases

View full text Add to dashboard Cite

show abstract

“…This allows for 100% sensitivity and 94% specificity, which is better than BAD-D, the best isolated parameter with a cut-off of 1.29 (87% sensitivity and 92.1% specificity). 5 Considering the calculated residual stromal bed of 281 and 301 µm, 1 the Ectasia Susceptibility Score-1 would be 96.75% and 79% for the right and left eye, respectively. Also, minimal re- Figure 1.…”

mentioning

confidence: 99%

Enhanced Ectasia Screening: The Need for Advanced and Objective Data

Ambrósio¹,

Luz²,

Lopes³

et al. 2014

J Refract Surg

Self Cite

View full text Add to dashboard Cite

Scheimpflug camera in the quantitative assessment of reproducibility of high‐speed corneal deformation during intraocular pressure measurement

Koprowski

Ambrósio²,

Reisdorf

2015

Journal of Biophotonics

View full text Add to dashboard Cite

The paper presents an original analysis method of corneal deformation images from the ultra-high-speed Scheimpflug camera (Corvis ST tonometer). Particular attention was paid to deformation frequencies exceeding 100 Hz and their reproducibility in healthy subjects examined repeatedly. A total of 4200 images with a resolution of 200 × 576 pixels were recorded. The data derived from 3 consecutive measurements from 10 volunteers with normal corneas. A new image analysis algorithm, written in Matlab with the use of the Image Processing package, adaptive image filtering, morphological analysis methods and fast Fourier transform, was proposed. The following results were obtained: (1) reproducibility of the eyeball reaction in healthy subjects with precision of 10%, (2) corneal vibrations with a frequency of 369 ± 65 Hz (3) and amplitude of 7.86 ± 1.28 µm, (4) the phase shift within two parts of the cornea of the same subject of about 150°. The result of image sequence analysis for one subject and deformations with a corneal frequency response above 100 Hz.

show abstract

Assessing ectasia susceptibility prior to LASIK: the role of age and residual stromal bed (RSB) in conjunction to Belin-Ambrósio deviation index (BAD-D)

Abstract: Purpose: To compare the ability to detect preoperative ectasia risk among LASIK candidates using classic ERSS (Ectasia Risk age and RSB provided 100% sensitivity and 94% specificity, with better AUC (0.989; 95% CI: 0.969 to 0.998)

Cited by 40 publications

References 23 publications

Enhanced Screening for Ectasia Risk prior to Laser Vision Correction

Enhanced Screening for Ectasia Risk prior to Laser Vision Correction

Enhanced Ectasia Screening: The Need for Advanced and Objective Data

Scheimpflug camera in the quantitative assessment of reproducibility of high‐speed corneal deformation during intraocular pressure measurement

Contact Info

Product

Resources

About