Diagnostic Accuracy of Corneal and Epithelial Thickness Map Parameters to Detect Keratoconus and Suspect Keratoconus

AIM: To establish the diagnostic accuracy of corneal and epithelial thickness measurements obtained by spectral-domain optical coherence tomography (SD-OCT) in detecting keratoconus (KC) and suspect keratoconus (SKC). METHODS: This retrospective study reviewed the data of 144 eyes separated into three groups by the Sirius automated corneal classification software: normal (N) (n = 65), SKC (n = 43), and KC (n = 36). Corneal thickness (CT) and epithelial thickness (ET) in the central (0–2 mm) and paracentral (2–5 mm) zones were obtained with the Cirrus high-definition OCT. Areas under the curve (AUC) of receiver operator characteristic (ROC) curves were compared across groups to estimate their discrimination capacity. RESULTS: ROC curve analysis revealed excellent predictive ability for ET variables: minimum (Min) ET (0_2), minimum-maximum (Min-Max) ET (0_2), superonasal-inferotemporal (SN-IT) ET (2_5), Min-Max ET (2_5), and Min ET (2_5) to detect keratoconus (AUC > 0.9, all). Min-Max CT (0_2) was the only CT parameter with excellent ability to discriminate between KC and N eyes (AUC = 0.94; cutoff = ≤−32 μm). However, both ET and CT variables were not strong enough (AUC < 0.8, all) to differentiate between SKC and N eyes, with the highest diagnostic power for Min-Max ET (2_5) (AUC = 0.71; cutoff = ≤−9 μm) and central corneal thickness (CCT) (AUC = 0.76; cutoff = ≤533 μm). CONCLUSION: These results demonstrate that OCT-derived CT and ET are able to differentiate between KC and N eyes, with a high level of certainty. However, Min-Max ET (2_5) was the parameter with the highest ability to detect suspect keratoconus.