{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:30:23Z","timestamp":1792449023144,"version":"4.5.0"},"reference-count":170,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Keratoconus is a progressive corneal disorder that can lead to irreversible visual impairment if not detected early. Despite its high prevalence, early diagnosis is often delayed, especially in low-to-middle-income countries due to limited awareness and restricted access to advanced diagnostic tools such as corneal topography, tomography, optical coherence tomography, and corneal biomechanical assessments. These technologies are essential for identifying early-stage keratoconus, yet their high cost limits accessibility in resource-limited settings. While cost and portability are important for accessibility, the sensitivity and specificity of diagnostic tools must be considered as primary metrics to ensure accurate and effective detection of early keratoconus. This review examines both traditional and advanced diagnostic techniques, including the use of machine learning and artificial intelligence, to enhance early diagnosis. Artificial intelligence-based approaches show significant potential for transforming keratoconus diagnosis by improving the accuracy and sensitivity of early diagnosis, especially when combined with imaging devices. Notable innovations include tools such as SmartKC, a smartphone-based machine-learning application, mobile corneal topography through the null-screen test, and the Smartphone-based Keratograph, providing affordable and portable solutions. Additionally, contrast sensitivity testing demonstrates potential for keratoconus detection, although a precise platform for routine clinical use has yet to be established. The review emphasizes the need for increased awareness among clinicians, particularly in underserved regions, and advocates for the development of accessible, low-cost diagnostic tools. Further research is needed to validate the effectiveness of these emerging technologies in detecting early keratoconus.<\/jats:p>","DOI":"10.3390\/jcm14020460","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T06:42:15Z","timestamp":1736750535000},"page":"460","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Strategies for Early Keratoconus Diagnosis: A Narrative Review of Evaluating Affordable and Effective Detection Techniques"],"prefix":"10.3390","volume":"14","author":[{"given":"Arige","family":"Gideon Abou Said","sequence":"first","affiliation":[{"name":"Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem 9101001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Gispets","sequence":"additional","affiliation":[{"name":"Department of Optics and Optometry, Universitat Polit\u00e8cnica de Catalunya, Violinista Vellsol\u00e0, 37, 08222 Terrassa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7842-5071","authenticated-orcid":false,"given":"Einat","family":"Shneor","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem 9101001, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.joco.2017.11.002","article-title":"Updates on Managements for Keratoconus","volume":"30","author":"Mohammadpour","year":"2018","journal-title":"J. Curr. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5005\/jp-journals-10025-1135","article-title":"Assessing Progression of Keratoconus and Cross-Linking Efficacy: The Belin ABCD Progression Display","volume":"6","author":"Belin","year":"2017","journal-title":"Int. J. Keratoconus Ectatic Corneal Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0161-6420(94)31313-3","article-title":"Prognostic Factors for the Progression of Keratoconus","volume":"101","author":"Tuft","year":"1994","journal-title":"Ophthalmology"},{"key":"ref_4","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":"Krachmer","year":"1984","journal-title":"Surv. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S0039-6257(97)00119-7","article-title":"Keratoconus","volume":"42","author":"Rabinowitz","year":"1998","journal-title":"Surv. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/ICO.0000000000001479","article-title":"Keratoconus and Personality\u2014A Review","volume":"37","author":"Mannis","year":"2018","journal-title":"Cornea"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.ajo.2009.10.021","article-title":"Long-Term Results of Riboflavin Ultraviolet A Corneal Collagen Cross-Linking for Keratoconus in Italy: The Siena Eye Cross Study","volume":"149","author":"Caporossi","year":"2010","journal-title":"Am. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/opo.13066","article-title":"Revisiting the Oil Droplet Sign in Keratoconus: Utility for Early Keratoconus Diagnosis and Screening","volume":"43","author":"Shneor","year":"2023","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_9","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":"Kobashi","year":"2017","journal-title":"Biomed. Res. Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/sjopt.sjopt_204_21","article-title":"Keratoconus Epidemiology: A Review","volume":"36","author":"Gomes","year":"2022","journal-title":"Saudi J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101333","DOI":"10.1016\/j.clae.2020.05.002","article-title":"Diagnostic Patterns in Keratoconus","volume":"44","author":"Kreps","year":"2021","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jcrs.2015.09.021","article-title":"Subclinical Keratoconus Detection by Pattern Analysis of Corneal and Epithelial Thickness Maps with Optical Coherence Tomography","volume":"42","author":"Li","year":"2016","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_13","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":"Millodot","year":"2011","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5005\/jp-journals-10025-1070","article-title":"Prevalence of Keratoconus among Young Arab Students in Israel","volume":"3","author":"Shneor","year":"2014","journal-title":"Int. J. Keratoconus Ectatic Corneal Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/opo.12147","article-title":"The Prevalence of Keratoconus in a Young Population in Mashhad, Iran","volume":"34","author":"Hashemi","year":"2014","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jfo.2011.03.016","article-title":"D\u00e9pistage Du K\u00e9ratoc\u00f4ne Dans Une Population Universitaire Au Liban","volume":"35","author":"Waked","year":"2012","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/opo.12706","article-title":"The Prevalence of Corneal Abnormalities in First-Degree Relatives of Patients with Keratoconus: A Prospective Case-Control Study","volume":"40","author":"Shneor","year":"2020","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"172","DOI":"10.2174\/1874364101509010172","article-title":"Prevalence of Keratoconus Among a Palestinian Tertiary Student Population","volume":"9","author":"Shehadeh","year":"2016","journal-title":"Open Ophthalmol. J."},{"key":"ref_19","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":"Hashemi","year":"2013","journal-title":"Cornea"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1136\/bjophthalmol-2017-311391","article-title":"Prevalence of Keratoconus in Paediatric Patients in Riyadh, Saudi Arabia","volume":"102","author":"Netto","year":"2018","journal-title":"Br. J. Ophthalmol."},{"key":"ref_21","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":"Jonas","year":"2009","journal-title":"Am. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xu, L., Wang, Y.X., Guo, Y., You, Q.S., Jonas, J.B., and Beijing Eye Study Group (2012). Prevalence and Associations of Steep Cornea\/Keratoconus in Greater Beijing. The Beijing Eye Study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039313"},{"key":"ref_23","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":"Kennedy","year":"1986","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/j.1600-0420.2007.00981.x","article-title":"Incidence and Prevalence of Keratoconus in Denmark","volume":"85","author":"Nielsen","year":"2007","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_25","first-page":"1","article-title":"Clinical and Epidemiological Features of Keratoconus Genetic and External Factors in the Pathogenesis of the Disease","volume":"178","author":"Ihalainen","year":"1986","journal-title":"Acta Ophthalmol. Suppl."},{"key":"ref_26","first-page":"407","article-title":"Prevalence of Keratoconus Patients in Japan","volume":"89","author":"Tanabe","year":"1985","journal-title":"Nihon Ganka Gakkai Zasshi"},{"key":"ref_27","first-page":"795738","article-title":"The Genetic and Environmental Factors for Keratoconus","volume":"2015","author":"Millodot","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/OPX.0b013e31828da95c","article-title":"Is Consanguinity a Risk Factor for Keratoconus?","volume":"90","author":"Millodot","year":"2013","journal-title":"Optom. Vis. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.ophtha.2020.08.020","article-title":"Prevalence of Keratoconus Based on Scheimpflug Imaging: The Raine Study","volume":"128","author":"Chan","year":"2021","journal-title":"Ophthalmology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1136\/bjo.2008.147371","article-title":"Chasing the Suspect: Keratoconus","volume":"93","author":"Klyce","year":"2009","journal-title":"Br. J. Ophthalmol."},{"key":"ref_31","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":"Henriquez","year":"2020","journal-title":"J. Refract. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/ICO.0000000000000408","article-title":"Global Consensus on Keratoconus and Ectatic Diseases","volume":"34","author":"Gomes","year":"2015","journal-title":"Cornea"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Song, G., Jelly, E.T., Chu, K.K., Kendall, W.Y., and Wax, A. (2021). A Review of Low-Cost and Portable Optical Coherence Tomography. Prog. Biomed. Eng., 3.","DOI":"10.1088\/2516-1091\/abfeb7"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Trevethan, R. (2017). Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Front. Public. Health, 5.","DOI":"10.3389\/fpubh.2017.00307"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hafezi, N.L., and Hafezi, F. (2022). Developing Affordable, Portable and Simplistic Diagnostic Sensors to Improve Access to Care. Sensors, 22.","DOI":"10.3390\/s22031181"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1016\/j.jcrs.2011.04.033","article-title":"Repeatability of Automatic Measurements by a New Scheimpflug Camera Combined with Placido Topography","volume":"37","author":"Savini","year":"2011","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/j.jcrs.2009.11.012","article-title":"Corneal Volume, Pachymetry, and Correlation of Anterior and Posterior Corneal Shape in Subclinical and Different Stages of Clinical Keratoconus","volume":"36","author":"Vergara","year":"2010","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1016\/S0886-3350(99)00195-9","article-title":"KISA% Index: A Quantitative Videokeratography Algorithm Embodying Minimal Topographic Criteria for Diagnosing Keratoconus","volume":"25","author":"Rabinowitz","year":"1999","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1001\/archopht.1995.01100070044023","article-title":"Comparison of Methods for Detecting Keratoconus Using Videokeratography","volume":"113","author":"Maeda","year":"1995","journal-title":"Arch. Ophthalmol."},{"key":"ref_40","unstructured":"Uma, S., and Koushik, T. (2023). Corneal Topography. StatPearls, StatPearls."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e933","DOI":"10.1111\/aos.14433","article-title":"Subclinical Keratoconus Detection with Three-Dimensional (3-D) Morphogeometric and Volumetric Analysis","volume":"98","author":"Toprak","year":"2020","journal-title":"Acta Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Castro-luna, G., Jim\u00e9nez-rodr\u00edguez, D., Casta\u00f1o-fern\u00e1ndez, A.B., and P\u00e9rez-rueda, A. (2021). Diagnosis of Subclinical Keratoconus Based on Machine Learning Techniques. J. Clin. Med., 10.","DOI":"10.3390\/jcm10184281"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/S0161-6420(90)32516-2","article-title":"Topographic Changes in Contact Lens-Induced Corneal Warpage","volume":"97","author":"Wilson","year":"1990","journal-title":"Ophthalmology"},{"key":"ref_44","first-page":"2749","article-title":"Automated Keratoconus Screening with Corneal Topography Analysis","volume":"35","author":"Maeda","year":"1994","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1111\/opo.12956","article-title":"Evaluation of Corneal Topography, Pachymetry and Higher Order Aberrations for Detecting Subclinical Keratoconus","volume":"42","author":"Kandel","year":"2022","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1016\/j.jcrs.2009.03.050","article-title":"Keratoconus: Classification Scheme Based on Videokeratography and Clinical Signs","volume":"35","author":"Li","year":"2009","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s40662-024-00386-1","article-title":"Multi-Modal Imaging for the Detection of Early Keratoconus: A Narrative Review","volume":"11","author":"Sabbagh","year":"2024","journal-title":"Eye Vis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ajo.2017.06.031","article-title":"Keratoconus Screening Indices and Their Diagnostic Ability to Distinguish Normal From Ectatic Corneas","volume":"181","author":"Shetty","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"ref_49","first-page":"204","article-title":"Galilei Corneal Tomography for Screening of Refractive Surgery Candidates: A Review of the Literature, Part II","volume":"8","author":"Moshirfar","year":"2019","journal-title":"Med. Hypothesis Discov. Innov. Ophthalmol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2732","DOI":"10.4103\/ijo.IJO_2111_20","article-title":"Simplifying and Understanding Various Topographic Indices for Keratoconus Using Scheimpflug Based Topographers","volume":"68","author":"Doctor","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"228","DOI":"10.18240\/ijo.2021.02.08","article-title":"Evaluation of Corneal Topographic, Tomographic and Biomechanical Indices for Detecting Clinical and Subclinical Keratoconus: A Comprehensive Three-Device Study","volume":"14","author":"Heidari","year":"2021","journal-title":"Int. J. Ophthalmol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1177\/11206721211060139","article-title":"Sensitivity and Specificity of Sirius Indices in Diagnosis of Keratoconus and Suspect Keratoconus","volume":"32","author":"Salman","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1109\/TBME.2008.923766","article-title":"Estimating Corneal Surface Topography in Videokeratoscopy in the Presence of Strong Signal Interference","volume":"55","author":"Iskander","year":"2008","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"214","DOI":"10.4103\/ijo.IJO_1263_20","article-title":"Pediatric Keratoconus\u2014Current Perspectives and Clinical Challenges","volume":"69","author":"Anitha","year":"2021","journal-title":"Indian J. Ophthalmol."},{"key":"ref_55","unstructured":"Moshirfar, M., Duong, A., and Ronquillo, Y. (2022). Corneal Imaging. StatPearls, StatPearls Publishing."},{"key":"ref_56","unstructured":"Sinjab, M.M. (2021). Corneal Tomography in Clinical Practice (Pentacam System): Basics and Clinical Interpretation, Jaypee Brothers Medical Publishers (P) Ltd.. [4th ed.]."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Kanclerz, P., Khoramnia, R., and Wang, X. (2021). Current Developments in Corneal Topography and Tomography. Diagnostics, 11.","DOI":"10.3390\/diagnostics11081466"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.optom.2019.11.001","article-title":"A Review of Corneal Imaging Methods for the Early Diagnosis of Pre-Clinical Keratoconus","volume":"13","author":"Masiwa","year":"2020","journal-title":"J. Optom."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1177\/1120672118760146","article-title":"Comparative Evaluation of Scheimpflug Tomography Parameters between Thin Non-Keratoconic, Subclinical Keratoconic, and Mild Keratoconic Corneas","volume":"28","author":"Huseynli","year":"2018","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.4103\/ijo.IJO_2129_19","article-title":"Evaluation of Corneal Topography and Tomography in Fellow Eyes of Unilateral Keratoconus Patients for Early Detection of Subclinical Keratoconus","volume":"68","author":"Thulasidas","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1167\/tvst.10.9.32","article-title":"Detection of Subclinical Keratoconus With a Validated Alternative Method to Corneal Densitometry","volume":"10","author":"Consejo","year":"2021","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1177\/1120672121991725","article-title":"Topographic, Elevation, and Keratoconus Indices for Diagnosis of Keratoconus by a Combined Placido and Scheimpflug Topography System","volume":"31","author":"Gharieb","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"99","DOI":"10.4274\/tjo.89587","article-title":"Evaluation of Scheimpflug Tomography Parameters in Subclinical Keratoconus, Clinical Keratoconus and Normal Caucasian Eyes","volume":"48","author":"Huseynli","year":"2018","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/ICO.0000000000002205","article-title":"A Combined Biomechanical and Tomographic Model for Identifying Cases of Subclinical Keratoconus","volume":"39","author":"Atalay","year":"2020","journal-title":"Cornea"},{"key":"ref_65","first-page":"177","article-title":"Pentacam\u00ae Corneal Tomography for Screening of Refractive Surgery Candidates: A Review of the Literature, Part I","volume":"8","author":"Motlagh","year":"2019","journal-title":"Med. Hypothesis Discov. Innov. Ophthalmol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/08820538.2022.2152716","article-title":"The Evolution of Diagnostics for Keratoconus: From Ophthalmometry to Biomechanics","volume":"38","author":"Bevara","year":"2023","journal-title":"Semin. Ophthalmol."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Niazi, S., Jim\u00e9nez-Garc\u00eda, M., Findl, O., Gatzioufas, Z., Doroodgar, F., Shahriari, M.H., and Javadi, M.A. (2023). Keratoconus Diagnosis: From Fundamentals to Artificial Intelligence: A Systematic Narrative Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13162715"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.4103\/IJO.IJO_766_24","article-title":"Combined Corneal Biomechanical and Tomographical Indices in Subclinical and Forme Fruste Keratoconus","volume":"72","author":"Ganesh","year":"2024","journal-title":"Indian J. Ophthalmol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2147\/OPTH.S443027","article-title":"Analysis of Scheimpflug Tomography Parameters for Detecting Subclinical Keratoconus in the Fellow Eyes of Patients with Unilateral Keratoconus in the Eastern Province of Saudi Arabia","volume":"18","author":"Somali","year":"2024","journal-title":"Clin. Ophthalmol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"324","DOI":"10.4274\/tjo.galenos.2023.68188","article-title":"Revisiting Pentacam Parameters in the Diagnosis of Subclinical and Mild Keratoconus Based on Different Grading System Definitions","volume":"53","author":"Toprak","year":"2023","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/11206721231199506","article-title":"Early, Forme Fruste Keratoconus and Normal Thin Cornea, Evaluation of Sensitive Parameters by Combined Placido Scheimpflug Topography","volume":"34","author":"Gharieb","year":"2024","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1097\/j.jcrs.0000000000001275","article-title":"Discrimination between Keratoconus, Forme Fruste Keratoconus, and Normal Eyes Using a Novel OCT-Based Tomographer","volume":"49","author":"Saad","year":"2023","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Chen, X., Cao, H., Huo, Y., Song, J., Zou, H., Li, J., Hou, J., and Wang, Y. (2023). Screening of Sensitive in Vivo Characteristics for Early Keratoconus Diagnosis: A Multicenter Study. Front. Bioeng. Biotechnol., 11.","DOI":"10.3389\/fbioe.2023.1158299"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jcjo.2017.08.010","article-title":"Ability of Novice Clinicians to Interpret High-Resolution Optical Coherence Tomography for Ocular Surface Lesions","volume":"53","author":"Yim","year":"2018","journal-title":"Can. J. Ophthalmol."},{"key":"ref_75","first-page":"82","article-title":"Optical Coherence Tomography","volume":"1","author":"Yehoshua","year":"2013","journal-title":"Retin. Fifth Ed."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ajo.2022.07.002","article-title":"Fourier Analysis on Irregular Corneal Astigmatism Using Optical Coherence Tomography in Various Severity Stages of Keratoconus","volume":"243","author":"Maeno","year":"2022","journal-title":"Am. J. Ophthalmol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/j.jcrs.0000000000000498","article-title":"Keratoconus Detection Using OCT Corneal and Epithelial Thickness Map Parameters and Patterns","volume":"47","author":"Yang","year":"2021","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1097\/j.jcrs.0000000000000990","article-title":"Systematic Detection of Keratoconus in OCT: Corneal and Epithelial Thickness Maps","volume":"48","author":"Dick","year":"2022","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"438","DOI":"10.3928\/1081597X-20210330-01","article-title":"Corneal Vertical and Horizontal Thickness Profiles Generated by UHR-OCT for Suspected and Subclinical Keratoconus Diagnosis","volume":"37","author":"Hu","year":"2021","journal-title":"J. Refract. Surg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.4103\/ijo.IJO_2399_20","article-title":"Advanced Epithelial Mapping for Refractive Surgery","volume":"68","author":"Khamar","year":"2020","journal-title":"Indian J. Ophthalmol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3928\/1081597X-20200925-01","article-title":"A Coincident Thinning Index for Keratoconus Identification Using OCT Pachymetry and Epithelial Thickness Maps","volume":"36","author":"Pavlatos","year":"2020","journal-title":"J. Refract. Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/02713683.2022.2088798","article-title":"Keratoconus: A Biomechanical Perspective","volume":"48","author":"Padmanabhan","year":"2022","journal-title":"Curr. Eye Res."},{"key":"ref_83","first-page":"233","article-title":"Detection of Subclinical Keratoconus","volume":"239","author":"Degle","year":"2022","journal-title":"Klin Monbl Augenheilkd"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1177\/11206721211063740","article-title":"Detecting Subclinical Keratoconus by Biomechanical Analysis in Tomographically Regular Keratoconus Fellow Eyes","volume":"32","author":"Augustin","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e27363","DOI":"10.2196\/27363","article-title":"Machine Learning Algorithms to Detect Subclinical Keratoconus: Systematic Review","volume":"9","author":"Maile","year":"2021","journal-title":"JMIR Med. Inf."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.jcrs.2018.12.015","article-title":"Assessment of Corneal Biomechanical Parameters in Healthy and Keratoconic Eyes Using Dynamic Bidirectional Applanation Device and Dynamic Scheimpflug Analyzer","volume":"45","author":"Herber","year":"2019","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Xian, Y., Zhao, Y., Sun, L., Zhang, X., Ding, L., Liu, Z., Li, Y., Ding, Y., Jiang, L., and Zhou, X. (2023). Comparison of Bilateral Differential Characteristics of Corneal Biomechanics between Keratoconus and Normal Eyes. Front. Bioeng. Biotechnol., 11.","DOI":"10.3389\/fbioe.2023.1163223"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Peyman, A., Sepahvand, F., Pourazizi, M., Noorshargh, P., and Forouhari, A. (2023). Corneal Biomechanics in Normal and Subclinical Keratoconus Eyes. BMC Ophthalmol., 23.","DOI":"10.1186\/s12886-023-03215-6"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1097\/ICO.0000000000003273","article-title":"Comparison of Ectasia Detection in Early Keratoconus Using Scheimpflug-Based Corneal Tomography and Biomechanical Assessments","volume":"42","author":"Wallace","year":"2023","journal-title":"Cornea"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ajo.2023.10.015","article-title":"Performance of Corvis ST Parameters Including Updated Stress-Strain Index in Differentiating Between Normal, Forme-Fruste, Subclinical, and Clinical Keratoconic Eyes","volume":"258","author":"Miao","year":"2024","journal-title":"Am. J. Ophthalmol."},{"key":"ref_91","unstructured":"Kaur, K., and Gurnani, B. (2022). Slit-Lamp Biomicroscope. StatPearls, StatPearls Publishing."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/cxo.12579","article-title":"Clinical Biomicroscopy and Retinoscopy Findings of Keratoconus in a Middle Eastern Population","volume":"101","author":"Naderan","year":"2018","journal-title":"Clin. Exp. Optom."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00347-021-01460-y","article-title":"Early Diagnosis of Keratoconus","volume":"119","author":"Lang","year":"2022","journal-title":"Ophthalmologe"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1038\/s41433-020-1039-1","article-title":"A Review of Imaging Modalities for Detecting Early Keratoconus","volume":"35","author":"Zhang","year":"2021","journal-title":"Eye"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1097\/ICO.0000000000001843","article-title":"Retinoscopy as a Screening Tool for Keratoconus","volume":"38","author":"Oraba","year":"2019","journal-title":"Cornea"},{"key":"ref_96","unstructured":"Song, A.L., and Rizzuti, A. (2023). Optical Biometry. StatPearls, StatPearls Publishing."},{"key":"ref_97","unstructured":"Gurnani, B., and Kaur, K. (2022). Keratometer. StatPearls, StatPearls Publishing."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.jcrs.2014.08.043","article-title":"Effect of Keratoconus Grades on Repeatability of Keratometry Readings: Comparison of 5 Devices","volume":"41","author":"Hashemi","year":"2015","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.clae.2015.01.015","article-title":"Can Retinoscopy Keep up in Keratoconus Diagnosis?","volume":"38","author":"Goebels","year":"2015","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3494982","article-title":"SmartKC: Smartphone-Based Corneal Topographer for Keratoconus Detection","volume":"Volume 5","author":"Gairola","year":"2021","journal-title":"Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies"},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Gairola, S., Joshi, P., Balasubramaniam, A., Murali, K., Kwatra, N., and Jain, M. (2022, January 11\u201315). Keratoconus Classifier for Smartphone-Based Corneal Topographer. Proceedings of the 2022 44th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), Scotland, UK.","DOI":"10.1109\/EMBC48229.2022.9871744"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1364\/AO.449875","article-title":"Smartphone-Based Corneal Topography with Null-Screens","volume":"61","year":"2022","journal-title":"Appl. Opt."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Campos-Garc\u00eda, M., Aguirre-Aguirre, D., Lechuga-N\u00fa\u00f1ez, J.A., and Pe\u00f1a-Conzuelo, A. (2019, January 24\u201326). Design of a Null-Screen for a Compact Corneal Topographer. Proceedings of the Modeling Aspects in Optical Metrology VII, Munich, Germany.","DOI":"10.1117\/12.2526241"},{"key":"ref_104","unstructured":"Kaur, K., and Gurnani, B. (2022). Contrast Sensitivity, StatPearls Publishing."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Shneor, E., Pi\u00f1ero, D.P., and Doron, R. (2021). Contrast Sensitivity and Higher-Order Aberrations in Keratoconus Subjects. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-92396-5"},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Awad, E.A., Abou Samra, W.A., Torky, M.A., and El-Kannishy, A.M. (2017). Objective and Subjective Diagnostic Parameters in the Fellow Eye of Unilateral Keratoconus. BMC Ophthalmol., 17.","DOI":"10.1186\/s12886-017-0584-2"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.clae.2011.07.001","article-title":"Forward Light Scatter and Contrast Sensitivity in Keratoconic Patients","volume":"35","author":"Jinabhai","year":"2012","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1136\/bjo.2003.027029","article-title":"Contrast and Glare Testing in Keratoconus and after Penetrating Keratoplasty","volume":"88","author":"Pesudovs","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s40123-022-00609-5","article-title":"The Characteristics of Quick Contrast Sensitivity Function in Keratoconus and Its Correlation with Corneal Topography","volume":"12","author":"Ling","year":"2023","journal-title":"Ophthalmol. Ther."},{"key":"ref_110","first-page":"251584142110127","article-title":"Advances in the Diagnosis and Treatment of Keratoconus","volume":"13","author":"Atalay","year":"2021","journal-title":"Ther. Adv. Ophthalmol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"44","DOI":"10.51329\/mehdiophthal1493","article-title":"Keratoconus: Imaging Modalities and Management","volume":"13","author":"Alqudah","year":"2024","journal-title":"Med. Hypothesis Discov. Innov. Ophthalmol."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ICO.0000000000002781","article-title":"Keratoconus: Diagnosis and Staging","volume":"41","author":"Belin","year":"2022","journal-title":"Cornea"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1016\/j.ophtha.2008.08.004","article-title":"Keratoconus Diagnosis with Optical Coherence Tomography Pachymetry Mapping","volume":"115","author":"Li","year":"2008","journal-title":"Ophthalmology"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1111\/cxo.12874","article-title":"Optical Coherence Tomography Imaging in Keratoconus","volume":"102","author":"Yip","year":"2019","journal-title":"Clin. Exp. Optom."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.1038\/s41433-024-03199-7","article-title":"Inter-Zonal Epithelial Thickness Differences for Early Keratoconus Detection Using Optical Coherence Tomography","volume":"38","author":"Naujokaitis","year":"2024","journal-title":"Eye"},{"key":"ref_116","first-page":"347","article-title":"Early Identification of Keratoconus Using Pachymetric Indexes Obtained with Spectral Domain Optical Coherence Tomography","volume":"172","author":"Scuderi","year":"2021","journal-title":"Clin. Ter."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.2147\/OPTH.S392665","article-title":"Keratoconus Diagnosis and Treatment: Recent Advances and Future Directions","volume":"17","author":"Bui","year":"2023","journal-title":"Clin. Ophthalmol."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/j.jcrs.0000000000000691","article-title":"Concordance of Keratoconus in Monozygotic Twins before and after Combined Corneal Crosslinking\/Photorefractive Keratectomy (Athens Protocol) Using Scheimpflug and OCT Tomography","volume":"48","author":"Vingopoulos","year":"2022","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"259","DOI":"10.3928\/1081597X-20100218-01","article-title":"Epithelial, Stromal, and Total Corneal Thickness in Keratoconus: Three-Dimensional Display with Artemis Very-High Frequency Digital Ultrasound","volume":"26","author":"Reinstein","year":"2010","journal-title":"J. Refract. Surg."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4103\/meajo.meajo_207_22","article-title":"Understanding Corneal Epithelial Thickness Mapping","volume":"29","author":"Alghamdi","year":"2023","journal-title":"Middle East. Afr. J. Ophthalmol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"276","DOI":"10.4103\/ojo.ojo_336_22","article-title":"Role of Corneal Epithelial Mapping, Corvis Biomechanical Index, and Artificial Intelligence-Based Tomographic Biomechanical Index in Diagnosing Spectrum of Keratoconus","volume":"16","author":"Kenia","year":"2023","journal-title":"Oman J. Ophthalmol."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1016\/j.ophtha.2012.06.023","article-title":"Corneal Epithelial Thickness Mapping by Fourier-Domain Optical Coherence Tomography in Normal and Keratoconic Eyes","volume":"119","author":"Li","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1097\/j.jcrs.0000000000001542","article-title":"Forme Fruste Keratoconus Detection with OCT Corneal Topography Using Artificial Intelligence Algorithms","volume":"50","author":"Mourgues","year":"2024","journal-title":"J. Cataract. Refract. Surg."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/IIO.0000000000000172","article-title":"Biomechanical Diagnostics of the Cornea","volume":"57","author":"Dupps","year":"2017","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"11971","DOI":"10.1038\/s41598-021-91263-7","article-title":"Corneal Biomechanical Parameters in Keratoconus Eyes with Abnormal Elevation on the Back Corneal Surface Only versus Both Back and Front Surfaces","volume":"11","author":"Sedaghat","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"11971","DOI":"10.1007\/s10792-024-03057-1","article-title":"Corneal Biomechanics and Diagnostics: A Review","volume":"44","author":"Komninou","year":"2024","journal-title":"Int. Ophthalmol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1136\/bjophthalmol-2014-305120","article-title":"Early Diagnosis of Keratoconus: What Difference Is It Making?","volume":"98","author":"Marcos","year":"2014","journal-title":"Br. J. Ophthalmol."},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Redaelli, E., Nana, M., Calvo, B., Matas, J.F.R., Luraghi, G., Rozema, J., and Grasa, J. (2024). Improving Early Detection of Keratoconus by Non Contact Tonometry. A Computational Study and New Biomarkers Proposal. J. Mech. Behav. Biomed. Mater., 152.","DOI":"10.1016\/j.jmbbm.2024.106413"},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Ren, S., Xu, L., Fan, Q., Gu, Y., and Yang, K. (2021). Accuracy of New Corvis ST Parameters for Detecting Subclinical and Clinical Keratoconus Eyes in a Chinese Population. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-84370-y"},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Rueda, A., Jim\u00e9nez-Rodr\u00edguez, D., and Castro-Luna, G. (2021). Diagnosis of Subclinical Keratoconus with a Combined Model of Biomechanical and Topographic Parameters. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132746"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1136\/bjo.2010.188300","article-title":"Air-Pulse Corneal Applanation Signal Curve Parameters for the Characterisation of Keratoconus","volume":"95","author":"Mikielewicz","year":"2011","journal-title":"Br. J. Ophthalmol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1167\/iovs.09-3689","article-title":"Screening of Forme Fruste Keratoconus with the Ocular Response Analyzer","volume":"51","author":"Schweitzer","year":"2010","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"496382","DOI":"10.1155\/2015\/496382","article-title":"Multivariate Analysis of the Ocular Response Analyzer\u2019s Corneal Deformation Response Curve for Early Keratoconus Detection","volume":"2015","author":"Galletti","year":"2015","journal-title":"J. Ophthalmol."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4103\/0301-4738.179725","article-title":"Detection of the Early Keratoconus Based on Corneal Biomechanical Properties in the Refractive Surgery Candidates","volume":"64","author":"Pniakowska","year":"2016","journal-title":"Indian J. Ophthalmol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1080\/02713683.2022.2041042","article-title":"Biomechanics in Keratoconus Diagnosis","volume":"48","author":"Esporcatte","year":"2023","journal-title":"Curr. Eye Res."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3928\/1081597X-20190417-01","article-title":"Detection of Subclinical Corneal Ectasia Using Corneal Tomographic and Biomechanical Assessments in a Japanese Population","volume":"35","author":"Koh","year":"2019","journal-title":"J. Refract. Surg."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.ophtha.2023.10.011","article-title":"Subclinical Keratoconus Detection and Characterization Using Motion-Tracking Brillouin Microscopy","volume":"131","author":"Randleman","year":"2024","journal-title":"Ophthalmology"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/aos.13493","article-title":"Von Helmholtz\u2019s Ophthalmometer: Historical Review and Experience with One of the Last Surviving Original Devices","volume":"96","author":"Godefrooij","year":"2018","journal-title":"Acta Ophthalmol."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"394","DOI":"10.4103\/0301-4738.116058","article-title":"Imaging Modalities in Keratoconus","volume":"61","author":"Matalia","year":"2013","journal-title":"Indian J. Ophthalmol."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"312","DOI":"10.5811\/cpcem.2019.5.42793","article-title":"Munson\u2019s Sign: An Obvious Finding to Explain Acute Vision Loss","volume":"3","author":"Gold","year":"2019","journal-title":"Clin. Pract. Cases Emerg. Med."},{"key":"ref_141","first-page":"2537","article-title":"Baseline Findings in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study","volume":"39","author":"Zadnik","year":"1998","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.clae.2010.04.006","article-title":"Keratoconus: A Review","volume":"33","author":"Wolffsohn","year":"2010","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1442-9071.1989.tb00487.x","article-title":"Keratoconus: Diagnosis and Management","volume":"17","author":"Lawless","year":"1989","journal-title":"Aust. N. Z. J. Ophthalmol."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1038\/sj.eye.6702902","article-title":"Higher-Order Wavefront Aberration and Letter-Contrast Sensitivity in Keratoconus","volume":"22","author":"Okamoto","year":"2008","journal-title":"Eye"},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"4130643","DOI":"10.1155\/2020\/4130643","article-title":"The Correlation between Corneal Findings and Disease Severity in Keratoconus per Scheimpflug Corneal Tomography","volume":"2020","author":"Shehata","year":"2020","journal-title":"J. Ophthalmol."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/00003226-199603000-00006","article-title":"Biomicroscopic Signs and Disease Severity in Keratoconus","volume":"15","author":"Zadnik","year":"1996","journal-title":"Cornea"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/bjo.79.4.396-a","article-title":"Automated ESR Analysis in 20 Minutes","volume":"79","author":"Harvey","year":"1995","journal-title":"Br. J. Ophthalmol."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1136\/bjo.78.6.510-a","article-title":"Ophthalmoscopic Sign of Early Keratoconus","volume":"78","author":"Pathmanathan","year":"1994","journal-title":"Br. J. Ophthalmol."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/bjo.79.4.396-b","article-title":"Ophthalmoscopic Sign of Early Keratoconus","volume":"79","author":"Nartey","year":"1995","journal-title":"Br. J. Ophthalmol."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1007\/s00417-023-06307-7","article-title":"Corneal Biomechanics in Early Diagnosis of Keratoconus Using Artificial Intelligence","volume":"262","author":"Huo","year":"2024","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_151","first-page":"CD014911","article-title":"Artificial Intelligence for Detecting Keratoconus","volume":"11","author":"Vandevenne","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1177\/11206721211073442","article-title":"Comparison of Artificial Intelligence-Based Machine Learning Classifiers for Early Detection of Keratoconus","volume":"32","author":"Mohammadpour","year":"2022","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/APO.0000000000000644","article-title":"Localized Corneal Biomechanical Alteration Detected In Early Keratoconus Based on Corneal Deformation Using Artificial Intelligence","volume":"12","author":"Chen","year":"2023","journal-title":"Asia Pac. J. Ophthalmol."},{"key":"ref_154","doi-asserted-by":"crossref","unstructured":"Goodman, D., and Zhu, A.Y. (2024). Utility of Artificial Intelligence in the Diagnosis and Management of Keratoconus: A Systematic Review. Front. Ophthalmol., 4.","DOI":"10.3389\/fopht.2024.1380701"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1080\/08820538.2019.1620812","article-title":"A Review of Machine Learning Techniques for Keratoconus Detection and Refractive Surgery Screening","volume":"34","author":"Lin","year":"2019","journal-title":"Semin. Ophthalmol."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s00417-023-06154-6","article-title":"Comparison of Different Corneal Imaging Modalities Using Artificial Intelligence for Diagnosis of Keratoconus: A Systematic Review and Meta-Analysis","volume":"262","author":"Hashemi","year":"2024","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_157","doi-asserted-by":"crossref","unstructured":"Yang, L., Qi, K., Zhang, P., Cheng, J., Soha, H., Jin, Y., Ci, H., Zheng, X., Wang, B., and Mei, Y. (2024). Diagnosis of Forme Fruste Keratoconus Using Corvis ST Sequences with Digital Image Correlation and Machine Learning. Bioengineering, 11.","DOI":"10.3390\/bioengineering11050429"},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"102284","DOI":"10.1016\/j.clae.2024.102284","article-title":"Artificial Intelligence in Corneal Diseases: A Narrative Review","volume":"47","author":"Nguyen","year":"2024","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.survophthal.2021.08.004","article-title":"Artificial Intelligence Applications in Different Imaging Modalities for Corneal Topography","volume":"67","author":"Shanthi","year":"2022","journal-title":"Surv. Ophthalmol."},{"key":"ref_160","doi-asserted-by":"crossref","unstructured":"Cao, K., Verspoor, K., Sahebjada, S., and Baird, P.N. (2022). Accuracy of Machine Learning Assisted Detection of Keratoconus: A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030478"},{"key":"ref_161","first-page":"296","article-title":"Artificial Intelligence as Diagnostic Modality for Keratoconus: A Systematic Review and Meta-Analysis","volume":"19","author":"Afifah","year":"2024","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"ref_162","doi-asserted-by":"crossref","unstructured":"Zhang, Z., Wang, Y., Zhang, H., Samusak, A., Rao, H., Xiao, C., Abula, M., Cao, Q., and Dai, Q. (2023). Artificial Intelligence-Assisted Diagnosis of Ocular Surface Diseases. Front. Cell Dev. Biol., 11.","DOI":"10.3389\/fcell.2023.1133680"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1097\/ICO.0000000000003467","article-title":"Deep Learning Models Used in the Diagnostic Workup of Keratoconus: A Systematic Review and Exploratory Meta-Analysis","volume":"43","author":"Bodmer","year":"2024","journal-title":"Cornea"},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"1458356","DOI":"10.3389\/fmed.2024.1458356","article-title":"The Development of a Machine Learning Model to Train Junior Ophthalmologists in Diagnosing the Pre-Clinical Keratoconus","volume":"11","author":"Jiang","year":"2024","journal-title":"Front Med."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/ICU.0000000000000885","article-title":"Artificial Intelligence and Corneal Diseases","volume":"33","author":"Kang","year":"2022","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40662-024-00376-3","article-title":"Potential Applications of Artificial Intelligence in Image Analysis in Cornea Diseases: A Review","volume":"11","author":"Tey","year":"2024","journal-title":"Eye Vis."},{"key":"ref_167","first-page":"354","article-title":"Application of Artificial Intelligence in Ophthalmology: An Updated Comprehensive Review","volume":"19","author":"Hashemian","year":"2024","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Ren, S., Yang, K., Xu, L., Fan, Q., Gu, Y., Pang, C., and Zhao, D. (2023). Machine learning analysis with the comprehensive index of corneal tomographic and biomechanical parameters in detecting pediatric subclinical keratoconus. Front. Bioeng. Biotechnol., 11.","DOI":"10.3389\/fbioe.2023.1273500"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.ajo.2018.08.005","article-title":"Enhanced Tomographic Assessment to Detect Corneal Ectasia Based on Artificial Intelligence","volume":"195","author":"Lopes","year":"2018","journal-title":"Am. J. Ophthalmol."},{"key":"ref_170","doi-asserted-by":"crossref","unstructured":"Z\u00e9boulon, P., Debellemani\u00e8re, G., and Gatinel, D. (2020). Unsupervised Learning for Large-Scale Corneal Topography Clustering. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-73902-7"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/460\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:27:41Z","timestamp":1759919261000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/460"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,13]]},"references-count":170,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020460"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020460","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,13]]}}}