Diagnostic Value of Corneal Epithelial and Stromal Thickness Distribution Profiles in Forme Fruste Keratoconus and Subclinical Keratoconus

Purpose: To assess the diagnostic values of corneal epithelial and stromal thickness distribution characteristics in forme fruste keratoconus (FFKC) and subclinical keratoconus (KC). Methods: This cross-sectional study was conducted at VISSUM Innovation and Miguel Hernandez University, Alicante, Spain. Twenty-seven eyes (27 subjects) with FFKC, 50 eyes (50 subjects) with subclinical KC with a best spectacle corrected distance visual acuity ≥20/20 (Snellen) (grade zero KC according to the Red Temática de Investigación Cooperativa en Salud classification), and 66 control eyes (66 subjects) were included. Epithelial and stromal thicknesses and epithelium/stroma (E/S) thickness ratio at center, thinnest point, 5-, and 8-mm circles obtained from the MS-39 device (CSO, Firenze, Italy) were compared among the control, FFKC, and subclinical KC groups. Results: The FFKC group had thinner 8-mm superior-nasal epithelium and higher central E/S ratio compared with the control group ( P < 0.05). In the subclinical KC group, the E/S ratios in the 5-mm temporal and superior zones were higher than those in the control group ( P < 0.05). The FFKC and subclinical KC groups had thinner stroma compared with the control group ( P < 0.05). A two-parameter formula correctly classified 94% of the eyes with subclinical KC and 98.5% of the normals, whereas another three-parameter model had 75% sensitivity and 94.3% specificity for discriminating FFKC from normals. Conclusions: This study identified different epithelial distributional and behavioral patterns in eyes with FFKC and subclinical KC. Eyes with FFKC seem to have increased central E/S ratio and asymmetric superior-nasal epithelial thinning, whereas keratometric and volumetric alterations seem to be more prominent in subclinical KC.