title: Comparison of objective and subjective refractive surgery screening parameters between regular and high-resolution Scheimpflug imaging devices.
abstract: OBJECTIVE
  To compare objective and subjective metrics from regular and high-resolution Scheimpflug devices (Pentacam) to determine their equivalence and interchangeability for refractive surgery screening.
  
  
  METHODS
  Emory Vision at Emory University, Atlanta, Georgia, USA.
  
  
  METHODS
  Retrospective comparative case series.
  
  
  METHODS
  Eyes of consecutive screened refractive surgery patients were evaluated with high-resolution and regular Scheimpflug devices. Objective parameters evaluated included keratometry (K) values, central corneal thickness (CCT), and device-generated keratoconus screening indices. Masked expert reviewers subjectively graded images as normal, suspicious, or abnormal.
  
  
  RESULTS
  One hundred eyes of 50 patients were evaluated. The mean K values were not significantly different (anterior K: high resolution 1.21 diopters [D] ± 1.13 (SD) versus regular 1.15 ± 1.16 D, P = 0.73; posterior K: 0.34 ± 0.23 D versus regular 0.35 ± 0.23 D, P = .67). The mean CCT was significantly thinner in the high-resolution group (514.7 ± 26.6 μm versus 527.6 ± 27.6 μm (P < .0001) with limits of agreement of -12.9 to +17.5 μm. Most keratoconus screening indices were more suspicious with the high-resolution device than with the regular device except the indices of height asymmetry and height deviation. Subjectively, 60% of cases received the same score, high resolution was more suspicious in 28% of cases, and regular was more suspicious in 12% of cases; there was only slight subjective agreement between technologies (κ = 0.26 to 0.31).
  
  
  CONCLUSIONS
  Regular and high-resolution Scheimpflug imaging devices generated different objective values and significantly different subjective interpretations with poor inter-reviewer agreement. The high-resolution device provided a more conservative overall output. For refractive surgical screening, the 2 devices are not interchangeable.
  
  
  BACKGROUND
  Proprietary or commercial disclosures are listed after the references.
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil. Electronic address: jrandle@emory.edu.
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Randleman
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
authors.forename: Jihan
authors.initials: J
authors.lastname: Akhtar
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
authors.forename: Renato
authors.initials: R
authors.lastname: Ambrósio
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
authors.forename: William J
authors.initials: WJ
authors.lastname: Dupps
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Krueger
authors.affiliation: From the Department of Ophthalmology (Randleman, Akhtar) and the Department of Biostatistics and Bioinformatics (Lynn), Rollins School of Public Health, Emory University, and Emory Vision (Randleman, Akhtar), Emory Eye Center, Atlanta, Georgia, the Cleveland Clinic Cole Eye Institute (Dupps, Krueger), the Department of Biomedical Engineering (Dupps), the Lerner Research Institute and the Transplant Center (Dupps), Surgery Institute, Cleveland Clinic, the Department of Biomedical Engineering (Dupps), Case Western Reserve University, Cleveland, Ohio, the Department of Ophthalmology (Klyce), Mount Sinai School of Medicine, New York, New York, USA; Instituto de Olhos Renato Ambrósio (Ambrósio), Rio de Janeiro Corneal Tomography and Biomechanics Study Group (Ambrósio), Rio de Janeiro, the Department for Ophthalmology of the Federal University of São Paulo (Ambrósio), São Paulo, Brazil.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Klyce
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology*; D063171:Corneal Pachymetry; D048988:Corneal Surgery, Laser; D019781:Corneal Topography; D003952:Diagnostic Imaging / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography; D012030:Refractive Errors / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D055815:Young Adult