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Refractive Eyecare article by Dr. Wang and Dr. Kugler, on pseudo keratoconus

December 2010

Wang Vision 3D Cataract and LASIK Center, Nashville, Tennessee

As corneal topographers become more sensitive, they pick up more conditions that resemble—but are actually something different from—forme fruste keratoconus. We suggest a means to distinguish between forme fruste keratoconus and non-ectatic conditions that produce a similar topographic picture.

Ever more sensitive corneal topographers are increasing our ability to detect the anterior corneal changes indicative of FFKC. But with increased sensitivity comes decreased specificity, and the increased detection of anterior surface changes resemble but are not FFKC. In this situation, it is important to be able to confirm or rule out the presence of FFKC. This is possible by looking at the posterior cornea. Studies suggest that in the natural history of keratoconus, posterior elevation precedes front surface topographic abnormalities. Hence, anterior steepening without concomitant posterior elevation is not FFKC. This may impact decisions about a patient’s candidacy for refractive surgery.


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