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Purpose  To characterize corneal structural changes in keratoconus using a new morphogeometric approach and to evaluate its potential diagnostic ability.    Methods  Comparative study including 464 eyes of 464 patients (age, 16 and 72 years) divided into two groups: control group (143 healthy eyes) and keratoconus group (321 keratoconus eyes). Topographic information (Sirius, CSO, Italy) was processed with SolidWorks v2012 and a solid model representing the geometry of each cornea was generated. The following parameters were defined: anterior (A ant ) and posterior (A post ) corneal surface areas, area of the cornea within the sagittal plane passing through the Z axis and the apex (A apexant , A apexpost ) and minimum thickness points (A mctant , A mctpost ) of the anterior and posterior corneal surfaces, and average distance from the Z axis to the apex (D apexant , D apexpost ) and minimum thickness points (D mctant , D mctpost ) of both corneal surfaces.    Results  Significant differences among control and keratoconus group were found in A apexant , A apexpost , A mctant , A mctpost , D apexant , D apexpost  (all p<0.001), A post  (p = 0.014), and D mctpost  (p = 0.035). Significant correlations in keratoconus group were found between A ant  and A post  (r = 0.836), A mctant  and A mctpost  (r = 0.983), and D mctant  and D mctpost  (r = 0.954, all p<0.001). A logistic regression analysis revealed that the detection of keratoconus grade I (Amsler Krumeich) was related to A post , A tot , A apexant , A mctant , A mctpost , D apexpost , D mctant  and D mctpost  (Hosmer-Lemeshow: p>0.05, R 2  Nagelkerke: 0.926). The overall percentage of cases correctly classified by the model was 97.30%.    Conclusions  Our morphogeometric approach based on the analysis of the cornea as a solid is useful for the characterization and detection of keratoconus.

A new approach to keratoconus detection based on corneal morphogeometric analysis