Influence of eye tilt on corneal densitometry

PURPOSE: To investigate whether Pentacam densitometry readings are affected by corneal tilt. METHODS: In a prospective study, the right eyes of 86 healthy participants aged 42.8 ± 20.0 years (range 18–79 years) were imaged using Scheimpflug tomography. Elevation maps were exported to calculate corneal tilt using custom‐made software, and densitometry readings were acquired directly from the corneal densitometry analysis add‐on to the standard software Oculus Pentacam HR. Simple mediation analysis was applied to study age as a confounding factor in the correlation between corneal tilt and corneal densitometry. RESULTS: Corneal tilt and corneal densitometry are not independent from one another because age is significantly correlated with both corneal tilt (r = 0.50, p < 0.001) and corneal densitometry (r = 0.91, p < 0.001). Only 3.8% of the correlation between tilt and densitometry operates directly, while the remaining 96.2% depends on age. CONCLUSIONS: Corneal tilt plays a role in corneal densitometry readings, even though the interaction is strongly influenced by age. Age is a well‐known factor in densitometry readings that should be taken into consideration when interpreting Scheimpflug densitometry.