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Epithelial thickness gradients (\u0394ET) were calculated as the difference between peripheral and central ET. Statistical comparisons were performed using non-parametric tests, with significance set at\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 396 eyes (208 keratoconus, 188 regular astigmatism) were analyzed. Central ET was significantly reduced in KC (38.55\u2009\u00b1\u20095.42\u00a0\u00b5m) vs controls (48.78\u2009\u00b1\u20093.94\u00a0\u00b5m;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). While peripheral thickness showed minor differences, the ET gradients (\u0394ET) were markedly steeper in KC across all quadrants (temporal, superior, nasal, inferior,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Within Stage I KC, eyes with more advanced disease exhibited steeper \u0394ET values, particularly in the nasal and temporal directions. Mean \u0394ET, demonstrated significant differences between KC (8.43\u2009\u00b1\u20094.97\u00a0\u00b5m) and controls (\u2212\u20091.55\u2009\u00b1\u20091.77\u00a0\u00b5m;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and correlated positively with steep keratometry (r\u2009=\u20090.521,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and negatively with thinnest corneal thickness (TCT) (r\u2009=\u2009\u2009\u2212\u20090.641,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\u0394ET is markedly steeper in keratoconus than in regular astigmatism\u2014even in Stage I\u2014and correlates with steep keratometry and TCT. With areas under the curves (AUCs) up to 0.976, \u0394ET provides a rapid, non-invasive epithelial-based biomarker for early detection and staging of keratoconus. Its utility for monitoring progression remains to be established in prospective longitudinal studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10792-026-04091-x","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:14:15Z","timestamp":1777461255000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epithelial thickness gradients as a diagnostic biomarker for early-stage keratoconus"],"prefix":"10.1007","volume":"46","author":[{"given":"Zane","family":"Jansone-Langina","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Gertnere","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viktorija","family":"Kezika","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Rocha-de-Lossada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9-Mar\u00eda","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"4091_CR1","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/s0039-6257(97)00119-7","volume":"42","author":"YS Rabinowitz","year":"1998","unstructured":"Rabinowitz YS (1998) Keratoconus. 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