Assessment of corneal biomechanical parameters in healthy and keratoconic eyes using dynamic bidirectional applanation device and dynamic Scheimpflug analyzer

J Cataract Refract Surg. 2019 Jun;45(6):778-788. doi: 10.1016/j.jcrs.2018.12.015. Epub 2019 Mar 20.


Purpose: To investigate corneal biomechanical parameters in healthy and keratoconic eyes using the Ocular Response Analyzer dynamic bidirectional applanation device (ORA) and the Corvis ST dynamic Scheimpflug analyzer (CST).

Setting: Department of Ophthalmology, Carl Gustav Carus University Hospital Dresden, Germany.

Design: Prospective, monocentric, case-control study.

Methods: Corneal biomechanical parameters were obtained in 60 eyes of 60 healthy participants (Group I) and 60 eyes of 60 keratoconus patients (Group II) with different grades of severity using the ORA and the CST. Participants were matched by age (Group I: 38.3 years ± 12.8 [SD], Group II: 37.3 ± 11.2 years) and intraocular pressure (Group I: 13.7 ± 1.7 mm Hg, Group II: 13.6 ± 1.5 mm Hg).

Results: For the ORA, the receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.950 for the keratoconus score, a sensitivity of 87% and a specificity of 93%. The AUC for the corneal resistant factor and corneal hysteresis was 0.930 and 0.868 with a sensitivity of 87% and a specificity of 87%, and sensitivity of 80% and a specificity of 80%, respectively. For the CST, the corneal biomechanical index showed the highest AUC (0.977) with a sensitivity of 97% and a specificity of 98%. The AUC of integrated radius (0.974; 90% sensitivity, 93% specificity) was followed by maximum inverse radius (0.962; 92% sensitivity, 93% specificity). Most parameters were able to discriminate healthy eyes from different keratoconus stages and early stages of keratoconus from moderate stages.

Conclusion: Both devices allowed for good differentiation between healthy eyes and keratoconic eyes and between different severity grades of keratoconus. Several parameters of ORA and CST revealed high sensitivity and specificity values for keratoconus detection.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Area Under Curve
  • Biomechanical Phenomena
  • Case-Control Studies
  • Cornea / physiopathology*
  • Corneal Topography
  • Elasticity / physiology*
  • Female
  • Healthy Volunteers
  • Humans
  • Intraocular Pressure / physiology
  • Keratoconus / physiopathology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity
  • Tonometry, Ocular
  • Young Adult