Biomechanical Responses of Healthy and Keratoconic Corneas Measured Using a Noncontact Scheimpflug-Based Tonometer

PURPOSE: To examine the repeatability of measurements obtained using a noncontact Scheimpflug-based tonometer (Corvis ST) and investigate potential differences in these parameters between healthy and keratoconic (KC) corneas. METHODS: Forty-five keratoconic eyes and 103 healthy eyes were examined using biomicroscopy, corneal tomography and the Corvis ST (CST). RESULTS: Intraocular pressure and central corneal thickness (CCT) were highly repeatable (intraclass correlation [ICC] > 0.70, coefficient of variation [CV] < 0.20). Deformation amplitude (DA) and applanation-1 time (A1T) were fairly repeatable (ICC > 0.60, CV < 0.20). There was no association between DA and age, sex, or ethnicity in healthy eyes. There was a greater mean DA in the KC group compared with 46 age-matched healthy eyes (KC 1.37 ± 0.21 mm, healthy 1.05 ± 0.11 mm, P < 0.001). Multivariate analysis showed DA in KC was predicted by IOP, CCT, and the steepest simulated keratometry value (P = 0.03, P = 0.03, P = 0.001 respectively, R(2) = 0.75). A subgroup analysis of healthy and KC eyes with comparable mean CCT and IOP highlighted a statistically significant difference in mean DA (KC 1.25 ± 0.08 mm, thin healthy 1.13 ± 0.09 mm, P = 0.006). Receiver-operating characteristic analysis showed an area under the curve of 0.77 (95% CI 0.61-0.93, P = 0.006) but no ideal cutoff value for DA. CONCLUSIONS: Key parameters assessed by the CST are repeatable. Keratoconus is associated with greater DA than in healthy eyes, even when controlled for CCT and IOP. Deformation amplitude may be a useful adjunct in keratoconus assessment and monitoring, but cannot solely discriminate between healthy and keratoconic corneas.