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This review focuses on the progress that has been made in the early detection of keratoconus using biomechanical and topographical properties derived from three different technologies, namely the ocular response analyser (ORA), corneal visualization Scheimpflug tonometer (Corvis ST) and optical coherence tomography (OCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A PubMed search was performed using the keywords of \u2018early keratoconus\u2019, \u2018subclinical keratoconus\u2019, \u2018forme fruste keratoconus\u2019, \u2018very asymmetric ectasia with normal topography\/tomography\u2019 and \u2018ocular response analyser\u2019 and\/or \u2018Corvis ST\u2019\/\u2018corneal visualized Scheimpflug tomographer\/tomography\u2019 and\/or \u2018optical coherence tomography\/tomographer\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The integration of biomechanical parameters and corneal morphological data from the topography\/tomography or OCT, or the assessment of bilateral asymmetry, has demonstrated improvement in the accuracy of diagnosing early-stage keratoconus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As measurement principles differ depending on the technique used for keratoconus assessment, comprehensive metrics may be needed to reflect subtle anterior or posterior corneal changes and help identify eyes with very early ectasia. Although clinical experts have always, and will most likely, continue to play a pivotal role in decision-making for early keratoconus diagnosis, future developments in technology and AI may lead to enhanced early detection in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40662-025-00435-3","type":"journal-article","created":{"date-parts":[[2025,5,11]],"date-time":"2025-05-11T22:11:41Z","timestamp":1747001501000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Early diagnosis of keratoconus using corneal biomechanics and OCT derived technologies"],"prefix":"10.1186","volume":"12","author":[{"given":"Xiaorui","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayo","family":"Maeno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizuka","family":"Koh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shihao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Quantock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si\u00e2n R.","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4517-4616","authenticated-orcid":false,"given":"Colm","family":"McAlinden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"issue":"12","key":"435_CR1","doi-asserted-by":"publisher","first-page":"e38","DOI":"10.1097\/ICO.0000000000000623","volume":"34","author":"JA Gomes","year":"2015","unstructured":"Gomes JA, Rapuano CJ, Belin MW, Ambr\u00f3sio R Jr, Group of panelists for the global Delphi panel of keratoconus and ectatic diseases. 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Data was collected in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants or their parents for those under the age of 18 years.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Outside the submitted work, Dr McAlinden has received consultancy fees\/honorarium\/travel support (past 36 months) from: Atia Vision (Campbell, California, USA), Bausch and Lomb (Bridgewater, New Jersey, USA), Bayer (Leverkusen, Germany), British Society of Refractive Surgery (Oxford, UK), BVI (Li\u00e8ge, Belgium), Cutting Edge (Lab\u00e9ge, France),\u00a0Hoya\u00a0(Frankfurt, Germany), Knowledge Gate Group (Copenhagen, Denmark), Johnson & Johnson Surgical Vision (Santa Ana, California, USA), Keio University (Tokyo, Japan), Medevise Consulting SAS (Strasbourg, France), Portuguese Society of Ophthalmology (Coimbra, Portugal), Rayner (Worthing, UK), ROHTO (Tokyo, Japan), Royal College of Ophthalmologists (London, UK), SightGlass vision (Menlo Park, California, USA), Scope (Crawley, UK), SpyGlass (Aliso Viejo, California, USA), Sun Yat-sen University (Guangzhou, China), Thea pharmaceuticals (Clemont-Ferrand, France), Vold Vision (Arkansas, USA). Dr McAlinden developed the Quality of Vision (QoV) questionnaire and the Orthokeratology and Contact Lens Quality of Life Questionnaire (OCL-QoL), and has a financial interest in these tools. He also consults on topics including Rasch analysis, questionnaires, statistical analyses, and clinical\/surgical ophthalmology topics.\u00a0Dr\u00a0McAlinden\u00a0has been co-awarded research grants relating to diabetic eye disease from the Welsh Government and the Royal College of Ophthalmologists (unpaid roles) and\u00a0Catalytic funding from Health and Care Research Wales\u00a0to develop a\u00a0Centre for Vision Services Research.\u00a0Dr\u00a0McAlinden\u00a0is a council member and treasurer of the British Society for Refractive Surgery (unpaid role) and a PROM advisor to the\u00a0Royal College of Ophthalmologists\u00a0(unpaid role).\u00a0Dr\u00a0McAlinden\u00a0has undertaken paid peer reviews for Research Square\u00a0(Durham, North Carolina, USA).\u00a0Dr\u00a0McAlinden\u00a0is an\u00a0editorial\u00a0board\u00a0member for Graefe's Archive for Clinical and Experimental Ophthalmology, Eye and Vision, Archives of Medical Science, Journal of Clinical Medicine, Journal of Ophthalmology, and Journal of Clinical and Experimental Ophthalmology.\u00a0Dr\u00a0McAlinden\u00a0is an Associate Editor for Frontiers in Medicine\u2014Ophthalmology.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"18"}}