Ophthalmology ReportsOphthalmology ReportsОфтальмологические ведомости1998-71022412-5423Eco-Vector68810110.17816/OV688101IRMUXWReviewsНаучные обзорыReview ArticleEvolution of keratoconus diagnostic methodsЭволюция методов диагностики кератоконусаhttps://orcid.org/0009-0000-5013-25875222-9038SultygovaLida A.СултыговаЛида Адамовна
Russian Federation
lidalida-2016@mail.ruhttps://orcid.org/0000-0003-1013-69245252-6779TaevereMariiam R.ТаевереМариям Рамазановна
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

taeveremr@gmail.comhttps://orcid.org/0000-0003-0273-33073253-4790ShpakAlexander A.ШпакАлександр Анатольевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

a_shpak@inbox.ruS. Fyodorov Eye Microsurgery Federal State InstitutionНациональный медицинский исследовательский центр «Межотраслевой научно-технический комплекс „Микрохирургия глаза“ им. акад. С.Н. Фёдорова»12042026191991092207202517122025Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-ВекторCopyright ©; 2026,2026Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://journals.eco-vector.com/ov/article/view/688101

Timely detection of keratoconus is the most important objective of an ophthalmologist. Early detection and timely treatment reduce the risk of progression, poor prognosis, and unnecessary refractive procedures. This review discusses current methods for diagnosing keratoconus, including corneal topography, Scheimpflug tomography, assessment of corneal biomechanical properties, anterior segment optical coherence tomography, and confocal microscopy, and analyzes their advantages and limitations. The authors conclude that currently corneal topography is mainly a primary screening method for corneal ectasias. Scheimpflug tomography provides three-dimensional corneal images and remains the gold standard for the diagnosis of keratoconus. Software integration of Scheimpflug tomographers with assessment of corneal biomechanical properties provides valuable additional information. Also, advancements in anterior segment optical coherence tomography empower detection of corneal ectasias and assessment of their risk. Confocal microscopy is an auxiliary method that detects morphological signs of corneal ectasia, which is particularly important when other methods give inconclusive results. Further studies, including comparative ones, will improve the accuracy and informative value of diagnostic methods for keratoconus.

Своевременное выявление кератоконуса — важнейшая задача в работе врача-офтальмолога. Раннее выявление и своевременное лечение снижают риск прогрессирования и неблагоприятного течения заболевания, неоправданных рефракционных вмешательств. В представленном обзоре рассмотрены современные методы диагностики кератоконуса — кератотопография, Шаймпфлюг-томография, оценка биомеханических свойств роговицы, оптическая когерентная томография переднего отрезка глаза и конфокальная микроскопия, а также проанализированы их преимущества и ограничения. Проведённый анализ позволяет заключить, что кератотопография в настоящее время сохраняет своё значение преимущественно как метод первичного скрининга кератэктазий. Золотым стандартом диагностики кератоконуса всё так же остаётся Шаймпфлюг-томография, обеспечивающая получение трёхмерных изображений роговицы. Программное объединение приборов для Шаймпфлюг-томографии и оценки биомеханических свойств роговицы предоставляет ценную дополнительную информацию. Параллельно с этим совершенствование оптической когерентной томографии переднего отрезка глаза расширяет возможности выявления кератэктазий, а также оценки риска их возникновения. Конфокальная микроскопия выступает в роли вспомогательного метода, позволяющего обнаружить морфологические признаки кератэктатического процесса, что особенно актуально при неоднозначных результатах других методов исследования. Дальнейшие исследования, в том числе сравнительного характера, будут способствовать повышению точности и информативности диагностики кератоконуса.

reviewkeratoconusdiagnostic methodscorneal topographyScheimpflug tomographycorneal biomechanicsconfocal microscopyanterior segment optical coherence tomographyобзоркератоконусметоды диагностикикератотопографияШаймпфлюг-томографиябиомеханика роговицыконфокальная микроскопияоптическая когерентная томография переднего отрезка глазаGomes JA, Tan D, Rapuano CJ, et al. Global consensus on keratoconus and ectatic diseases. Cornea. 2015;34(4):359–369. doi: 10.1097/ICO.0000000000000408Santodomingo-Rubido J, Carracedo G, Suzaki A, et al. Keratoconus: An updated review. Cont Lens Anterior Eye. 2022;45(3):101559. doi: 10.1016/j.clae.2021.101559Bikbov MM, Kazakbaeva GM, Gilmanshin TR, et al. Prevalence and associations of keratoconus among children, adults, and elderly in the population-based Ural eye studies. Asia Pac J Ophthalmol (Phila). 2023;12(6):591–603. doi: 10.1097/APO.0000000000000639Rabinowitz YS, Rasheed K. KISA% index: a quantitative videokeratography algorithm embodying minimal topographic criteria for diagnosing keratoconus. J Cataract Refract Surg. 1999;25(10):1327–1335. doi: 10.1016/s0886-3350(99)00195-9Shi Y. Strategies for improving the early diagnosis of keratoconus. Clin Optom (Auckl). 2016;24(8):13–21. doi: 10.2147/OPTO.S63486Alonso-Caneiro D, Iskander DR, Collins MJ. Estimating corneal surface topography in videokeratoscopy in the presence of strong signal interference. IEEE Trans Biomed Eng. 2008;55(10):2381–2387. doi: 10.1109/TBME.2008.923766Salman A, Darwish T, Ali A, et al. Sensitivity and specificity of Sirius indices in diagnosis of keratoconus and suspect keratoconus. Eur J Ophthalmol. 2021;23:11206721211060139. doi: 10.1177/11206721211060139Averich VV. Modern methods of diagnosis and monitoring of keratoconus. The eye glaz. 2023;25(4):322–330. doi: 10.33791/2222-4408-2023-4-322-330 EDN: QOHNAUMalyugin BE, Shpak AA, editors. Modern methods of visualization of the anterior segment of the eye. Moscow: Oftalmologiya; 2023. 128 p. (In Russ.)Chan C, Saad A, Randleman BJ, et al. Analysis of cases and accuracy of 3 risk scoring systems in predicting ectasia after laser in situ keratomileusis. J Cataract Refract Surg. 2018;44(8):979–992. doi: 10.1016/j.jcrs.2018.05.013Chan C, Ang M, Saad A, et al. Validation of an objective scoring system for forme fruste keratoconus detection and post-LASIK ectasia risk. Assessment in Asian Eyes. Cornea. 2015;34(9):996–1004. doi: 10.1097/ICO.0000000000000529Belin MW, Ambrósio R. Scheimpflug imaging for keratoconus and ectatic disease. Indian J Ophthalmol. 2013;61(8):401–406. doi: 10.4103/0301-4738.116059Saad A, Gatinel D. Validation of a new scoring system for the detection of early form of keratoconus. Int J Keratoconus Ectatic Corneal Dis. 2012;1(2):100–108. doi: 10.5005/jp-journals-10025-1019Lopes BT, Belin MW, Henriquez MA, et al. Enhancing corneal ectasia susceptibility detection: analysis of a new algorithm (BAD-D v4). Sci Rep. 2024;14(1):30226. doi: 10.1038/s41598-024-81809-wBelin M, Kundu G, Shetty N, et al. ABCD: A new classification for keratoconus. Indian J Ophthalmol. 2020;68(12):2831–2834. doi: 10.4103/ijo.IJO_2078_20Hashemi H, Khabazkhoob M, Pakzad R, et al. Pentacam accuracy in discriminating keratoconus from normal corneas: a diagnostic evaluation study. Eye Contact Lens. 2019;45(1):46–50. doi: 10.1097/ICL.0000000000000531Yousefi A, Hashemi H, Khanlari M, et al. Keratometric indices for detecting the type of keratoconus: a combined discriminant analysis. Clin Exp Optom. 2020;103(4):463–468. doi: 10.1111/cxo.13001Zaabaar E, Kyei S, Parkson Brew MAA, et al. The utility of measures of anterior segment parameters of a Pentacam Scheimpflug tomographer in discriminating high myopic astigmatism from keratoconus. PLoS One. 2021;16(12):e0260648. doi: 10.1371/journal.pone.0260648Flynn TH, Sharma DP, Bunce C, et al. Differential precision of corneal Pentacam HR measurements in early and advanced keratoconus. Br J Ophthalmol. 2016;100(9):1183–1187. doi: 10.1136/bjophthalmol-2015-307201Kreps EO, Jimenez-Garcia M, Issarti I, et al. Repeatability of the Pentacam HR in Various Grades of Keratoconus. Am J Ophthalmol. 2020;219: 154–162. doi: 10.1016/j.ajo.2020.06.013Ambrósio R, Ramos I, Luz A, et al. Dynamic ultra-high speed Scheimpflug imaging for assessing corneal biomechanical properties. Revista Brasileira de Oftalmologia. 2013;(72):99–102. doi: 10.1590/S0034-72802013000200005Ortiz D, Piñero D, Shabayek MH, et al. Corneal biomechanical properties in normal, post-laser in situ keratomileusis, and keratoconic eyes. J Cataract Refract Surg. 2007;33(8):1371–1375. doi: 10.1016/j.jcrs.2007.04.021Schweitzer C, Roberts CJ, Mahmoud AM, et al. Screening of forme fruste keratoconus with the ocular response analyzer. Invest Ophthalmol Vis Sci. 2010;51(5):2403–2410. doi: 10.1167/iovs.09-3689Esporcatte LPG, Salomão MQ, Lopes BT, et al. Biomechanics in keratoconus diagnosis Curr Eye Res. 2023;48(2):130–136. doi: 10.1080/02713683.2022.2041042Vinciguerra R, Ambrósio R, Elsheikh A, et al. Detection of keratoconus with a new biomechanical index. J Refract Surg. 2016;32(12):803–810. doi: 10.3928/1081597X-20160629-01Ambrósio R, Lopes BT, Faria-Correia F, et al. Integration of Scheimpflug-based corneal tomography and biomechanical assessments for enhancing ectasia detection. J Refract Surg. 2017;33(7):434–443. doi: 10.3928/1081597X-20170426-02Kataria P, Padmanabhan P, Gopalakrishnan A, et al. Accuracy of Scheimpflug-derived corneal biomechanical and tomographic indices for detecting subclinical and mild keratectasia in a South Asian population. J Cataract Refract Surg. 2019;45(3):328–336. doi: 10.1016/j.jcrs.2018.10.030Flockerzi E, Vinciguerra R, Belin MW, Vinciguerra P. Combined biomechanical and tomographic keratoconus staging: Adding a biomechanical parameter to the ABCD keratoconus staging system. Acta Ophthalmol. 2022;100(5):e1135–e1142. doi: 10.1111/aos.15044Certificate of state registration of computer program No. 2024618260/10.04.2024. Solodkova EG, Balalin SV, Sibakin DD. Program for the implementation of an algorithm for assessing the biomechanical properties of the cornea (corneal rigidity) in determining the stages of keratoconus. (In Russ.)Avetisov SE, Averich VV, Pateyuk LS. Keratoconus: main lines of research. Russian Annals of Ophthalmology. 2023;139(3–2):11–20. doi: 10.17116/oftalma202313903211 EDN: XUBVSFHollingsworth JG, Efron N, Tullo AB. In vivo corneal confocal microscopy in keratoconus. Ophthalmic Physiol Opt. 2005;25(3):254–260. doi: 10.1111/j.1475-1313.2005.00278.xHollingsworth JG, Efron N. Observations of banding patterns (Vogt striae) in keratoconus: a confocal microscopy study. Cornea. 2005;24(2):162–166. doi: 10.1097/01.ico.0000141231.03225.d8Wygledowska-Promieńska D, Rokita-Wala I, Gierek-Ciaciura S, Piatek-Koronowska G. The alterations in corneal structure at III/IV stage of keratoconus by means of confocal microscopy and ultrasound biomicroscopy before penetrating keratoplasty. Klin Oczna. 1999;101(6):427–432. (In Polish)Efron N, Hollingsworth JG. New perspectives on keratoconus as revealed by corneal confocal microscopy. Clin Exp Optom. 2008;91(1):34–55. doi: 10.1111/j.1444-0938.2007.00195.xKu JY, Niederer RL, Patel DV, et al. Laser scanning in vivo confocal analysis of keratocyte density in keratoconus. Ophthalmology. 2008;115(5): 845–850. doi: 10.1016/j.ophtha.2007.04.067Izmaylova S, et al. Revising the question of keratoconus classification. Int J Kerat Ect Cor Dis. 2018;7(1):82-89. doi: 10.5005/jp-journals-10025-1162Ferrini E, Posarelli C, Figus M, et al. A pilot study on Langerhans cells in keratoconus patients by in vivo confocal microscopy before and after corneal cross-linking and correlation with eye rubbing. Cont Lens Anterior Eye. 2024;47(5):102170. doi: 10.1016/j.clae.2024.102170Santos A, Filho J, Cenedeze M, et al. Increased inflammatory mediators in the ocular surface tissue in keratoconus. Mol Vis. 2024;2(30):279–288.Chirapapaisan C, Sawarot M, Kengpunpanich S. Subclinical corneal inflammation and subbasal nerve alterations in keratoconus detected by in vivo confocal microscopy: a cross-sectional study. Graefes Arch Clin Exp Ophthalmol. 2025;263(3):761–769. doi: 10.1007/s00417-024-06664-xLi Y, Tan O, Brass R, et al. Corneal epithelial thickness mapping by Fourier-domain optical coherence tomography in normal and keratoconic eyes. Ophthalmology. 2012;119(12):2425–2433. doi: 10.1016/j.ophtha.2012.06.023Kanellopoulos J, Asimellis G. OCT corneal epithelial topographic asymmetry as a sensitive diagnostic tool for early and advancing keratoconus. Clin Ophthalmol. 2014;8:2277–2287. doi: 10.2147/OPTH.S67902Haque S, Jones L, Simpson T. Thickness mapping of the cornea and epithelium using optical coherence tomography. Optom Vision Sci. 2008;85(10): E963–E976. doi: 10.1097/OPX.0b013e318188892cAsam JS, Polzer M, Tafreshi A, et al. Anterior Segment OCT. In: Bille J, editors. High resolution imaging in microscopy and ophthalmology: new frontiers in biomedical optics. Springer Cham; 2019. P. 285–299. doi: 10.1007/978-3-030-16638-0_13Kamiya K, Ayatsuka Y, Kato Y, et al. Keratoconus detection using deep learning of colour-coded maps with anterior segment optical coherence tomography: a diagnostic accuracy study. BMJ Open. 2019;9(9):e031313. doi: 10.1136/bmjopen-2019-031313Pavlatos E, Chen S, Chamberlain W, et al. Detection of corneal ectasia using OCT maps of pachymetry and posterior surface mean curvature. J Refract Surg. 2022;38(8):502–510. doi: 10.3928/1081597X-20220711-01Kuo AN, Cortina MS, Greiner MA, et al. Advanced corneal imaging in keratoconus: a report by the American Academy of Ophthalmology. Ophthalmology. 2024;131(1):107–121. doi: 10.1016/j.ophtha.2023.07.030Mourgues E, Saunier V, Smadja D, et al. Forme fruste keratoconus detection with OCT corneal topography using artificial intelligence algorithms. J Cataract Refract Surg. 2024;50(12):1247–1253. doi: 10.1097/j.jcrs.0000000000001542Kim K, Koh K, Lee S, Lee Y. Diagnostic validation of the screening corneal objective risk of ectasia analyzer evaluated by swept source optical coherence tomography for keratoconus in an Asian population. Bioengineering (Basel). 2023;10(11):1335. doi: 10.3390/bioengineering10111335Gadamer AM, Miklaszewski P, Janiszewska-Bil D, et al. Comparison of a Scheimpflug camera and optical coherence tomography in evaluating keratoconic eyes post keratoplasty. J Clin Med. 2025;14(1):238. doi: 10.3390/jcm14010238Feldman RM, Kim G, Chuang AZ, et al. Comparison between the CASIA SS-1000 and Pentacam in measuring corneal curvatures and corneal thickness maps. BMC Ophthalmol. 2023;23(1):10. doi: 10.1186/s12886-023-02768-wKim KY, Lee S, Jeon YJ, Min JS. Anterior segment characteristics in normal and keratoconus eyes evaluated with a new type of swept-source optical coherence tomography. PLoS One. 2022;17(9):e0274071. doi: 10.1371/journal.pone.0274071Saad A, Debellemanière G, Zeboulon P, et al. Discrimination between keratoconus, forme fruste keratoconus, and normal eyes using a novel OCT-based tomographer. J Cataract Refract Surg. 2023;49(11):1092–1097. doi: 10.1097/j.jcrs.0000000000001275Stolyarova LA, Imshanetskaya TA, Abelski DE. Optical coherence tomography in the diagnostics of keratoconus. Healthcare (Minsk). 2024;(9):10–18. EDN: CTUUBWYücekul B, Dick HB, Taneri S. Systematic detection of keratoconus in OCT: corneal and epithelial thickness maps. J Cataract Refract Surg. 2022;48(12):1360–1365. doi: 10.1097/j.jcrs.0000000000000990