{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:22:11Z","timestamp":1781587331506,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,4,14]],"date-time":"2015-04-14T00:00:00Z","timestamp":1428969600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To analyse tomographic changes in eyes classified as \u2018normal\u2019, \u2018keratoconus\u2010suspect\u2019 and \u2018clinically manifest keratoconus\u2019 based on the established <jats:styled-content style=\"fixed-case\">KISA<\/jats:styled-content>% definition of Rabinowitz and Rasheed and to develop the category of \u2018subclinical keratoconus eyes\u2019 to expand the classification into a \u2018subtopographic\u2019 range.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Tomographic and topographic analyses of 670 eyes performed with a rotating Scheimpflug imaging system (Pentacam<jats:sup><jats:bold>\u00ae<\/jats:bold><\/jats:sup>, Oculus Inc., Wetzlar, Germany) were retrospectively analysed. Based on the <jats:styled-content style=\"fixed-case\">KISA<\/jats:styled-content>% keratoconus classification system, eyes were assigned to a \u2018normal\u2019, \u2018keratoconus\u2010suspect\u2019 or \u2018manifest keratoconus\u2019 group. In addition, a new group of \u2018subclinical keratoconus eyes\u2019 was analysed, comprising unsuspicious fellow eyes of patients with keratoconus. T\u2010tests, Wilcoxon rank\u2010sum test, receiver operating characteristics (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) and robust regression analyses were performed to correlate tomographic parameters with the increasing <jats:styled-content style=\"fixed-case\">KISA<\/jats:styled-content>% index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">KISA<\/jats:styled-content>%\u2010grouped keratoconus eyes showed robust tomographic changes. By adding the subclinical group, although the concurrent topography was unchanged, we were able to demonstrate statistically significant changes for almost all tomographic parameters (parameters with highest sensitivity\/specificity: <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>_max, [0.69\/0.69], <jats:styled-content style=\"fixed-case\">BAD<\/jats:styled-content>_D [0.66\/0.66]). The highest coefficient of determination (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>) with the <jats:styled-content style=\"fixed-case\">KISA<\/jats:styled-content>% index was demonstrated for Ele_f_max (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.70), Ele_f_<jats:styled-content style=\"fixed-case\">TP<\/jats:styled-content> (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.69), Ele_b_<jats:styled-content style=\"fixed-case\">TP<\/jats:styled-content> (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.69) and <jats:styled-content style=\"fixed-case\">BAD<\/jats:styled-content>_D (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.68).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We recommend the use of the expanded KISA% index (<jats:styled-content style=\"fixed-case\">eKISA<\/jats:styled-content>% index) as the basis for the definition of keratoconus and normal groups in future keratoconus research projects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.12590","type":"journal-article","created":{"date-parts":[[2015,4,14]],"date-time":"2015-04-14T07:55:29Z","timestamp":1428998129000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Correlation of the <scp>KISA<\/scp>% index and Scheimpflug tomography in \u2018normal\u2019, \u2018subclinical\u2019, \u2018keratoconus\u2010suspect\u2019 and \u2018clinically manifest\u2019 keratoconus eyes"],"prefix":"10.1111","volume":"93","author":[{"given":"Johannes","family":"Steinberg","sequence":"first","affiliation":[{"name":"Department of Ophthalmology UKE \u2010 University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"Care\u2010Vision Germany University Medical Center Hamburg\u2010Eppendorf Hamburg 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