Central Corneal Thickness Measurement Using Ultrasonic Pachymetry, Rotating Scheimpflug Camera, and Scanning-slit Topography Exclusively in Thin Non-keratoconic Corneas

PURPOSE: To evaluate the agreement among Pentacam, Orbscan and ultrasound (US) pachymetry for measurement of central corneal thickness (CCT) in thin corneas with normal topographic pattern. METHODS: We included 88 eyes of 44 refractive surgery candidates with thinnest pachymetric readings of 500 micrometers (μm) or less on Orbscan, a normal topographic pattern, no sign of keratoconus, and best corrected visual acuity (BCVA) of 20/20. Pentacam, Orbscan and US were performed in one session by the same examiner. Exclusion criteria were history of ocular surgery, topographic abnormalities suggesting forme fruste keratoconus or keratectasia, and recent contact lens wear. RESULTS: The difference in CCT measurements by US pachymetry and Orbscan II [using an acoustic factor (AF) of 0.92] ranged from −34 to +34 μm. The difference between the thinnest point and central readings measured by US reached 16 μm with Orbscan II (AF: 0.92) and 2 μm with Pentacam. Mean differences between the employed devices were 0.2 μm for Pentacam versus US (P = 0.727), 30.1 μm for uncorrected Orbscan versus US (P < 0.001), 10.4 μm for Orbscan II (AF = 0.92) versus US (P < 0.001), and 0.2 μm for Orbscan II (AF = 0.94) versus US (P = 0.851). CONCLUSION: In normal thin corneas, Pentacam demonstrated better agreement with US pachymetry as compared to corrected Orbscan readings. Results achieved by Orbscan were better consistent with US pachymetry using an AF of 0.94. We speculate that a dynamically graded AF in reverse proportion to CCT constitutes a better approach for correcting Orbscan measurements.