{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T08:54:26Z","timestamp":1776848066579,"version":"3.51.2"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T00:00:00Z","timestamp":1581897600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wilmer Biostatistics Core","award":["EY01765"],"award-info":[{"award-number":["EY01765"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Ophthalmology"],"published-print":{"date-parts":[[2020,2,17]]},"abstract":"<jats:p><jats:italic>Purpose<\/jats:italic>. This study aims to correlate the clinical signs of keratoconus (KC) which include superficial apical scarring, Fleischer rings, and Vogt striae with best spectacle-corrected visual acuity (BSCVA) and corneal tomography findings.<jats:italic>Patients and methods<\/jats:italic>. A retrospective observational study. 72 consecutive KC patients seen by the senior author over the course of one year were included in this case series. Eyes with pellucid marginal degeneration, postrefractive ectasia, history of a corneal graft, prior corneal collagen cross-linking, intracorneal ring segments or hydrops were excluded from analysis. Subsequently, the final analysis included only treatment-na\u00efve KC eyes with varying degrees of disease severity.<jats:italic>Results<\/jats:italic>. BSCVA with manifest refraction was 0.5\u2009logMAR higher in eyes with apical scarring (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:mrow><\/mml:math>). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43\u2009logMAR higher in the former,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.009<\/mml:mn><\/mml:mrow><\/mml:math>). Eyes with apical scarring had higher keratometry readings (<jats:italic>K<\/jats:italic>2\u2009=\u200964.56\u2009\u00b1\u200912.89\u2009D versus 49.07\u2009\u00b1\u20096.61\u2009D,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:mrow><\/mml:math>); this was also true for eyes with Fleischer rings compared with ring-free eyes (<jats:italic>K<\/jats:italic>2\u2009=\u200956.23\u2009\u00b1\u200911.52\u2009D versus 48.91\u2009\u00b1\u20097.79\u2009D,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>&lt;<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:mrow><\/mml:math>) and eyes with Vogt striae (<jats:italic>K<\/jats:italic>2\u2009=\u200956.19\u2009\u00b1\u200910.27\u2009D versus 50.68\u2009\u00b1\u20099.21\u2009D,<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.01<\/mml:mn><\/mml:mrow><\/mml:math>). Atopic disease was a risk factor for scarring: odds ratio (OR)\u2009=\u20092.87 (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.03<\/mml:mn><\/mml:mrow><\/mml:math>). The OR of observing Fleischer rings in KC eyes was 12% per year (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:mrow><\/mml:math>). Additionally, each mm of corneal apex displacement from the pupillary center led to a 0.76\u2009logMAR increase in visual acuity (<mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\"><mml:mrow><mml:mi>p<\/mml:mi><mml:mo>=<\/mml:mo><mml:mn>0.001<\/mml:mn><\/mml:mrow><\/mml:math>).<jats:italic>Conclusion<\/jats:italic>. The presence of apical scarring and Fleischer rings on biomicroscopy can aid the clinician in making the distinction between severe or long-standing disease (respectively). Apical scarring is a sign of advanced disease and is associated with worse BSCVA and tomography findings. Fleischer rings are markers of intermediate disease and their presence correlates with disease duration.<\/jats:p>","DOI":"10.1155\/2020\/4130643","type":"journal-article","created":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T23:31:42Z","timestamp":1581982302000},"page":"1-6","source":"Crossref","is-referenced-by-count":9,"title":["The Correlation between Corneal Findings and Disease Severity in Keratoconus per Scheimpflug Corneal Tomography"],"prefix":"10.1155","volume":"2020","author":[{"given":"Ahmed E. M.","family":"Shehata","sequence":"first","affiliation":[{"name":"The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James W.","family":"Foster","sequence":"additional","affiliation":[{"name":"The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert S.","family":"Jun","sequence":"additional","affiliation":[{"name":"The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1678-6437","authenticated-orcid":true,"given":"Uri S.","family":"Soiberman","sequence":"additional","affiliation":[{"name":"The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1016\/0039-6257(84)90094-8"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1016\/s0039-6257(97)00119-7"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-199603000-00006"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-200007000-00020"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-200011000-00009"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2007.03.001"},{"key":"7","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2013-304132"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.05-0981"},{"issue":"4","key":"9","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3928\/1081-597X-19970701-16","volume":"13","year":"1997","journal-title":"Journal of Refractive Surgery"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1097\/01.ico.0000164831.87593.08"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.4103\/0974-9233.114791"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1097\/ico.0000000000000504"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1097\/ico.0000000000000623"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.13-12437"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1976.03910040409017"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2008.04.016"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.10-7093"}],"container-title":["Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/joph\/2020\/4130643.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/joph\/2020\/4130643.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/joph\/2020\/4130643.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,15]],"date-time":"2022-10-15T20:23:14Z","timestamp":1665865394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/joph\/2020\/4130643\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,17]]},"references-count":17,"alternative-id":["4130643","4130643"],"URL":"https:\/\/doi.org\/10.1155\/2020\/4130643","relation":{},"ISSN":["2090-004X","2090-0058"],"issn-type":[{"value":"2090-004X","type":"print"},{"value":"2090-0058","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,17]]}}}