{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:57:31Z","timestamp":1789588651635,"version":"build-2803163510"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Keratoconus (KC) is a progressive corneal disorder resulting in severe visual impairment. We aimed to determine the prevalence and corneal tomographic characteristics of KC and keratoconus suspect (KCS) in a population-based study, and to construct discrimination models with or without corneal tomography. A total of 1,544 eyes (822 participants aged \u226535 years) were evaluated using data from the Yamagata Study (2015\u20132017). Systemic and ophthalmological examinations including corneal tomography with swept-source anterior segment optical coherence tomography (AS-OCT) were conducted to determine the prevalence and corneal tomographic characteristics of KC and KCS. In addition, data on 766 eyes were used to construct discrimination models with or without corneal tomography. In results, KC was diagnosed in six (0.85%) participants, and KCS was diagnosed in 27 (1.46%) participants. The values including corneal power, keratometric cylinder, corneal central and thinnest thickness, corneal asymmetry, higher-order irregularity, and their inter-eye differences were associated with KC and KCS. The areas under the receiver operating characteristic curves for the three multivariate discrimination models (without corneal tomography, with corneal tomography, and without corneal tomography + inter-eye difference models) for participants with KC or KCS were 0.848, 1.000, and 0.930, respectively. When corneal tomography is unavailable, inter-eye differences in corneal parameters may be useful screening tools for KC and KCS.<\/jats:p>","DOI":"10.1371\/journal.pone.0308892","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T18:24:52Z","timestamp":1737051892000},"page":"e0308892","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence of keratoconus and keratoconus suspect, and their characteristics on corneal tomography in a population-based study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3879-7970","authenticated-orcid":true,"given":"Hiroyuki","family":"Namba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6509-9054","authenticated-orcid":true,"given":"Naoyuki","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Utsunomiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Kaneko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Ishizawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Nishitsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"pone.0308892.ref001","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0039-6257(84)90094-8","article-title":"Keratoconus and related noninflammatory corneal thinning disorders","volume":"28","author":"JH Krachmer","year":"1984","journal-title":"Surv Ophthalmol"},{"key":"pone.0308892.ref002","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0039-6257(97)00119-7","article-title":"Keratoconus","volume":"42","author":"YS Rabinowitz","year":"1998","journal-title":"Surv Ophthalmol"},{"key":"pone.0308892.ref003","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/ICO.0000000000000408","article-title":"Global consensus on keratoconus and ectatic diseases","volume":"34","author":"JA Gomes","year":"2015","journal-title":"Cornea"},{"key":"pone.0308892.ref004","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/00003226-200210000-00008","article-title":"Between-eye asymmetry in keratoconus","volume":"21","author":"K Zadnik","year":"2002","journal-title":"Cornea"},{"key":"pone.0308892.ref005","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1111\/j.1444-0938.2005.tb06687.x","article-title":"Between eye asymmetry in keratoconus in an Indian population","volume":"88","author":"I Chopra","year":"2005","journal-title":"Clin Exp Optom"},{"key":"pone.0308892.ref006","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1097\/ICO.0b013e31827b14ae","article-title":"Intereye asymmetry detected by Scheimpflug imaging in subjects with normal corneas and keratoconus","volume":"32","author":"MA Henriquez","year":"2013","journal-title":"Cornea"},{"key":"pone.0308892.ref007","doi-asserted-by":"crossref","first-page":"e108882","DOI":"10.1371\/journal.pone.0108882","article-title":"Evaluation of intereye corneal asymmetry in patients with keratoconus. A scheimpflug imaging study","volume":"9","author":"L Dienes","year":"2014","journal-title":"PLOS ONE"},{"key":"pone.0308892.ref008","first-page":"164","article-title":"Automated topographic screening for keratoconus in refractive surgery candidates","volume":"22","author":"NS Kalin","year":"1996","journal-title":"CLAO J"},{"key":"pone.0308892.ref009","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/j.jcrs.2007.06.034","article-title":"Corneal ectasia after LASIK in one eye and uneventful PRK in the fellow eye","volume":"33","author":"M. Mohammadpour","year":"2007","journal-title":"J Cataract Refract Surg"},{"key":"pone.0308892.ref010","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ophtha.2007.03.073","article-title":"Risk assessment for ectasia after corneal refractive surgery","volume":"115","author":"JB Randleman","year":"2008","journal-title":"Ophthalmology"},{"key":"pone.0308892.ref011","doi-asserted-by":"crossref","first-page":"906","DOI":"10.3928\/1081597X-20100428-02","article-title":"Corneal ectasia after LASIK despite low preoperative risk: tomographic and biomechanical findings in the unoperated, stable, fellow eye","volume":"26","author":"R Ambr\u00f3sio","year":"2010","journal-title":"J Refract Surg"},{"key":"pone.0308892.ref012","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/S0002-9394(02)02220-1","article-title":"Riboflavin\/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus","volume":"135","author":"G Wollensak","year":"2003","journal-title":"Am J Ophthalmol"},{"key":"pone.0308892.ref013","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1186\/s12886-017-0657-2","article-title":"Efficacy and safety of transepithelial corneal collagen crosslinking surgery versus standard corneal collagen crosslinking surgery for keratoconus: a meta-analysis of randomized controlled trials","volume":"17","author":"W Li","year":"2017","journal-title":"BMC Ophthalmol"},{"key":"pone.0308892.ref014","doi-asserted-by":"crossref","first-page":"8145651","DOI":"10.1155\/2017\/8145651","article-title":"Corneal collagen cross-linking for keratoconus: systematic review","volume":"2017","author":"H Kobashi","year":"2017","journal-title":"BioMed Res Int"},{"key":"pone.0308892.ref015","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1167\/iovs.13-12929","article-title":"Impact of keratoconus in the better eye and the worse eye on vision-related quality of life","volume":"55","author":"S Sahebjada","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref016","first-page":"2749","article-title":"Automated keratoconus screening with corneal topography analysis","volume":"35","author":"N Maeda","year":"1994","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref017","doi-asserted-by":"crossref","first-page":"5546","DOI":"10.1167\/iovs.10-5369","article-title":"Topographic and tomographic properties of forme fruste keratoconus corneas","volume":"51","author":"A Saad","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref018","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1097\/ICO.0b013e3182a0d014","article-title":"Prevalence of keratoconus in a population-based study in Shahroud","volume":"32","author":"H Hashemi","year":"2013","journal-title":"Cornea"},{"key":"pone.0308892.ref019","first-page":"5","article-title":"Corneal diagnosis and evaluation with the oculus Pentacam","volume":"35","author":"MW Belin","year":"2007","journal-title":"Highlights Ophthalmol"},{"key":"pone.0308892.ref020","doi-asserted-by":"crossref","first-page":"847","DOI":"10.3928\/1081597X-20101006-01","article-title":"Imaging of the cornea: topography vs tomography","volume":"26","author":"R Ambr\u00f3sio","year":"2010","journal-title":"J Refract Surg"},{"key":"pone.0308892.ref021","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.jcrs.2011.10.027","article-title":"Reliability and repeatability of swept-source Fourier-domain optical coherence tomography and Scheimpflug imaging in keratoconus","volume":"38","author":"E Szalai","year":"2012","journal-title":"J Cataract Refract Surg"},{"key":"pone.0308892.ref022","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1016\/j.jcrs.2011.05.027","article-title":"Corneal topographic analysis in patients with keratoconus using 3-dimensional anterior segment optical coherence tomography","volume":"37","author":"T Nakagawa","year":"2011","journal-title":"J Cataract Refract Surg"},{"key":"pone.0308892.ref023","doi-asserted-by":"crossref","first-page":"OCT169","DOI":"10.1167\/iovs.15-18650","article-title":"Quantitative evaluation of the natural progression of keratoconus using three-dimensional optical coherence tomography","volume":"57","author":"H Fujimoto","year":"2016","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref024","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1136\/bjo.2008.147371","article-title":"Chasing the suspect: keratoconus","volume":"93","author":"SD Klyce","year":"2009","journal-title":"Br J Ophthalmol"},{"key":"pone.0308892.ref025","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.jcrs.2007.12.036","article-title":"Comparison of and correlation between anterior and posterior corneal elevation maps in normal eyes and keratoconus-suspect eyes","volume":"34","author":"Z Schlegel","year":"2008","journal-title":"J Cataract Refract Surg"},{"key":"pone.0308892.ref026","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3928\/1081597X-20200212-03","article-title":"A Systematic Review of Subclinical Keratoconus and Forme Fruste Keratoconus","volume":"36","author":"MA Henriquez","year":"2020","journal-title":"J Refract Surg"},{"key":"pone.0308892.ref027","doi-asserted-by":"crossref","first-page":"2912","DOI":"10.1167\/iovs.09-4304","article-title":"Biomechanical properties of keratoconus suspect eyes","volume":"51","author":"A Saad","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref028","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/eye.2000.154","article-title":"Does ethnic origin influence the incidence or severity of keratoconus?","volume":"14","author":"AR Pearson","year":"2000","journal-title":"Eye"},{"key":"pone.0308892.ref029","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/0002-9394(86)90817-2","article-title":"A 48-year clinical and epidemiologic study of keratoconus","volume":"101","author":"RH Kennedy","year":"1986","journal-title":"Am J Ophthalmol"},{"key":"pone.0308892.ref030","first-page":"1","article-title":"Clinical and epidemiological features of keratoconus genetic and external factors in the pathogenesis of the disease","volume":"178","author":"A Ihalainen","year":"1986","journal-title":"Acta Ophthalmol Suppl (1985)"},{"key":"pone.0308892.ref031","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ajo.2016.12.015","article-title":"Age-specific incidence and prevalence of keratoconus: A nationwide registration study","volume":"175","author":"DA Godefrooij","year":"2017","journal-title":"Am J Ophthalmol"},{"key":"pone.0308892.ref032","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1111\/aos.14082","article-title":"Incidence and prevalence of keratoconus in Denmark\u2014an update","volume":"97","author":"S Bak-Nielsen","year":"2019","journal-title":"Acta Ophthalmol"},{"key":"pone.0308892.ref033","doi-asserted-by":"crossref","first-page":"e694","DOI":"10.1111\/aos.14668","article-title":"Prevalence and incidence of keratoconus in Norway: a nationwide register study","volume":"99","author":"O Kristianslund","year":"2021","journal-title":"Acta Ophthalmol"},{"key":"pone.0308892.ref034","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3109\/09286586.2011.560747","article-title":"Prevalence and associated factors of keratoconus in Jerusalem: a cross-sectional study","volume":"18","author":"M Millodot","year":"2011","journal-title":"Ophthalmic Epidemiol"},{"key":"pone.0308892.ref035","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.ajo.2009.06.024","article-title":"Prevalence and associations of keratoconus in rural Maharashtra in central India: the central India eye and medical study","volume":"148","author":"JB Jonas","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"pone.0308892.ref036","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s10792-018-0965-4","article-title":"Prevalence and topographical characteristics of keratoconus in patients with refractive errors in the Egyptian delta","volume":"39","author":"HA Elbedewy","year":"2019","journal-title":"Int Ophthalmol"},{"key":"pone.0308892.ref037","doi-asserted-by":"crossref","first-page":"e39313","DOI":"10.1371\/journal.pone.0039313","article-title":"Prevalence and associations of steep cornea\/keratoconus in Greater Beijing. The Beijing Eye Study","volume":"7","author":"Beijing Eye Study Group","year":"2012","journal-title":"PLOS ONE"},{"key":"pone.0308892.ref038","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ajo.2018.04.027","article-title":"Prevalence and incidence of keratoconus in South Korea: A nationwide population-based study","volume":"192","author":"S Hwang","year":"2018","journal-title":"Am J Ophthalmol"},{"key":"pone.0308892.ref039","first-page":"407","article-title":"Prevalence of keratoconus patients in Japan","volume":"89","author":"U Tanabe","year":"1985","journal-title":"Nippon Ganka Gakkai Zasshi"},{"key":"pone.0308892.ref040","doi-asserted-by":"crossref","first-page":"920","DOI":"10.2337\/diacare.22.6.920","article-title":"Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study","volume":"22","author":"M Tominaga","year":"1999","journal-title":"Diabetes Care"},{"key":"pone.0308892.ref041","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1016\/j.ophtha.2006.02.052","article-title":"Cardiovascular risk factors and retinal microvascular signs in an adult Japanese population: the Funagata Study","volume":"113","author":"R Kawasaki","year":"2006","journal-title":"Ophthalmology"},{"key":"pone.0308892.ref042","doi-asserted-by":"crossref","first-page":"244","DOI":"10.3109\/09286586.2011.594206","article-title":"Determinants and risk factors for central corneal thickness in Japanese persons: the Funagata Study","volume":"18","author":"K Nishitsuka","year":"2011","journal-title":"Ophthalmic Epidemiol"},{"key":"pone.0308892.ref043","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1167\/iovs.14-15261","article-title":"Ocular higher-order wavefront aberrations in the Japanese adult population: the Yamagata Study (Funagata)","volume":"56","author":"H Namba","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref044","doi-asserted-by":"crossref","first-page":"e12894","DOI":"10.1097\/MD.0000000000012894","article-title":"Age-related variations in corneal geometry and their association with astigmatism: the Yamagata Study (Funagata)","volume":"97","author":"H Namba","year":"2018","journal-title":"Medicine"},{"key":"pone.0308892.ref045","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.ophtha.2008.12.022","article-title":"Anterior ocular biometry using 3-dimensional optical coherence tomography","volume":"116","author":"S Fukuda","year":"2009","journal-title":"Ophthalmology"},{"key":"pone.0308892.ref046","doi-asserted-by":"crossref","first-page":"e000058","DOI":"10.1136\/bmjophth-2016-000058","article-title":"In vivo crystalline lens measurements with novel swept-source optical coherent tomography: an investigation on variability of measurement","volume":"1","author":"T Shoji","year":"2017","journal-title":"BMJ Open Ophthalmol"},{"key":"pone.0308892.ref047","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s10384-013-0291-3","article-title":"Characteristics of corneal topographic and pachymetric patterns in patients with pellucid marginal corneal degeneration","volume":"58","author":"M Fuchihata","year":"2014","journal-title":"Jpn J Ophthalmol"},{"key":"pone.0308892.ref048","first-page":"171","article-title":"Fourier analysis of video-keratographic data. A tool for separation of spherical, regular astigmatic and irregular astigmatic corneal power components","volume":"15","author":"JO Hjortdal","year":"1995","journal-title":"Ophthalmic Physiol Opt"},{"key":"pone.0308892.ref049","first-page":"705","article-title":"Quantitative evaluation of irregular astigmatism by Fourier series harmonic analysis of videokeratography data","volume":"39","author":"T Oshika","year":"1998","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0308892.ref050","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1136\/bjo.60.7.522","article-title":"Aetiology of keratoconus","volume":"60","author":"AG Karseras","year":"1976","journal-title":"Br J Ophthalmol"},{"key":"pone.0308892.ref051","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1136\/bjo.84.8.834","article-title":"Atopy and keratoconus: a multivariate analysis","volume":"84","author":"AM Bawazeer","year":"2000","journal-title":"Br J Ophthalmol"},{"key":"pone.0308892.ref052","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/ICO.0b013e3181bdefbc","article-title":"Expanding our understanding of eye rubbing and keratoconus","volume":"29","author":"AN Carlson","year":"2010","journal-title":"Cornea"},{"key":"pone.0308892.ref053","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1364\/BOE.10.000622","article-title":"CorneaNet: fast segmentation of cornea OCT scans of healthy and keratoconic eyes using deep learning","volume":"10","author":"VA Dos Santos","year":"2019","journal-title":"Biomed Opt Express"},{"key":"pone.0308892.ref054","doi-asserted-by":"crossref","first-page":"e031313","DOI":"10.1136\/bmjopen-2019-031313","article-title":"Keratoconus detection using deep learning of colour-coded maps with anterior segment optical coherence tomography: a diagnostic accuracy study","volume":"9","author":"K Kamiya","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0308892.ref055","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1136\/bjophthalmol-2013-303829","article-title":"Cataract surgery outcome in eyes with keratoconus","volume":"98","author":"MP Watson","year":"2014","journal-title":"Br J Ophthalmol"},{"key":"pone.0308892.ref056","doi-asserted-by":"crossref","first-page":"194","DOI":"10.2174\/1874364101711010194","article-title":"Cataract surgery in patients with keratoconus: pearls and pitfalls","volume":"11","author":"F Aiello","year":"2017","journal-title":"Open Ophthalmol J"},{"issue":"Suppl 1","key":"pone.0308892.ref057","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s40123-019-00212-1","article-title":"Current trends in modern visual intraocular lens enhancement surgery in stable keratoconus: A synopsis of Do\u2019s, don\u2019ts and pitfalls","volume":"8","author":"I Vastardis","year":"2019","journal-title":"Ophthalmol Ther"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T18:25:16Z","timestamp":1737051916000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308892"}},"subtitle":[],"editor":[{"given":"Timo","family":"Eppig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":57,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308892","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]}}}