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Methods: This prospective case-control study included the eyes of 144 patients. Biomechanical and tomographic parameters were recorded (Corvis ST and Pentacam). Patients without clinical signs of keratoconus in both eyes but suspicious tomography findings were included in the Stable-KCS group (n = 72). Longitudinal follow-up was used to evaluate Stable-KCS changes. Unilateral keratoconus contralateral eyes with suspicious tomography were included in the SKC group (n = 72). T-tests and non-parametric tests were used for comparison. Multivariate general linear models were used to adjust for confounding factors for further analysis. Receiver operating characteristic (ROC) curves were used to analyze the distinguishability. Results: The biomechanical and tomographic parameters of Stable-KCS showed no progression during the follow-up time (13.19 \u00b1 2.41 months, p &gt; 0.05). Fifteen biomechanical parameters and the Stress\u2013Strain Index (SSI) differed between the two groups (p &lt; 0.016). The A1 dArc length showed the strongest distinguishing ability (area under the ROC = 0.888) between Stable-KCS and SKC, with 90.28% sensitivity and 77.78% specificity at the cut-off value of \u22120.0175. Conclusions: The A1 dArc length could distinguish between Stable-KCS and SKC, indicating the need to focus on changes in the A1 dArc length for keratoconus suspects during the follow-up period. Although both have abnormalities on tomography, the corneal biomechanics and SSI of Stable-KCS were stronger than those of SKC, which may explain the lack of progression of Stable-KCS.<\/jats:p>","DOI":"10.3390\/bioengineering11050420","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T08:08:32Z","timestamp":1714032512000},"page":"420","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Longitudinal Analysis of Corneal Biomechanics of Suspect Keratoconus: A Prospective Case-Control Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7368-4621","authenticated-orcid":false,"given":"Yan","family":"Huo","sequence":"first","affiliation":[{"name":"School of Medicine, Nankai University, Tianjin 300071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, Nankai University, Tianjin 300071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4835-045X","authenticated-orcid":false,"given":"Ruisi","family":"Xie","sequence":"additional","affiliation":[{"name":"School of Medicine, Nankai University, Tianjin 300071, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"School of Medicine, Northwest University, Xi\u2019an 710199, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Medicine, Nankai University, Tianjin 300071, China"},{"name":"Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China"},{"name":"Nankai Eye Institute, Nankai University, Tianjin 300071, China"},{"name":"Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin 300020, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1111\/cxo.12169","article-title":"Screening for keratoconus suspects among candidates for refractive surgery","volume":"97","author":"McMonnies","year":"2014","journal-title":"Clin. 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