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Three consecutive corneal epithelial aberration measurements were obtained with the MS-39 by two skilled operators. The intraobserver repeatability and interobserver reproducibility were evaluated using within-subject standard deviation (S\n                      <jats:sub>w<\/jats:sub>\n                      ), test\u2013retest variability (TRT), and intraclass correlation coefficient (ICC).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prospective study enrolled 141 eyes from 141 KC subjects. Subgroups included 32 eyes with FFKC, 29 with mild, 45 with moderate, and 35 with severe KC. In the FFKC, mild, moderate, and total groups, S\n                      <jats:sub>w<\/jats:sub>\n                      and TRT for intraobserver repeatability were \u2264\u20090.18\u00a0\u03bcm and \u2264\u20090.50\u00a0\u03bcm, respectively. ICCs were \u2265\u20090.884 for most parameters except trefoil and astigmatism II. The S\n                      <jats:sub>w<\/jats:sub>\n                      and TRT for interobserver reproducibility were \u2264 0.15\u00a0\u03bcm and \u2264\u20090.41\u00a0\u03bcm, respectively. ICCs were \u2265\u20090.917 except for trefoil and astigmatism II. In the severe group, the ICCs for intraobserver repeatability and interobserver reproducibility were 0.366 to 0.904 and 0.493 to 0.908.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The new MS-39 device demonstrated moderate-to-good precision in corneal epithelial aberration measurements for FFKC, mild, moderate and total KC. Despite the decrease associated with increasing KC severity, the potential of the device for early diagnosis and monitoring was still evident. The instrument\u2019s precision should be tailored to disease severity. Stage-specific TRT thresholds for epithelial aberration measurements were proposed for KC management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40662-026-00508-x","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T23:01:41Z","timestamp":1789858901000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Establishing a precision reference benchmark for corneal epithelial aberration measurements using a new hybrid device across keratoconus stages"],"prefix":"10.1186","volume":"13","author":[{"given":"Yizhou","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Ning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siheng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinning","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiran","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kexin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Savini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Schiano-Lomoriello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingtao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhai","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"issue":"4","key":"508_CR1","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.clae.2010.04.006","volume":"33","author":"M Romero-Jim\u00e9nez","year":"2010","unstructured":"Romero-Jim\u00e9nez M, Santodomingo-Rubido J, Wolffsohn JS. 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