1. Try to respond the questions before you open the branches
2. Click the small circle to open or close the branches
3. Left-click the background to move the map
4. Link to the lecture
5. How was Keratoconus traditionally been diagnosed by? When was the topography introduced?
5.1. Keratoconus was traditionally diagnosed by clinical signs such as Monsoon sign, severe deformity of the cornea
5.2. Corneal topography was introduced in the mid 80, for the diagnosis of keratoconus. But it was in the 90's that topographies began being used to exclude keratoconic corneas from having corneal refractive surgery (Double click the image)
6. What was the original purpose of the Keratoconus screening? How was the evolution of the Keratoconus screening?
6.1. Protocol to exclude keratoconic corneas from having corneal refractive surgery. Double click the image
6.1.1. Screening Evolution, new technologies Double click the image
7. How is the Keratoconus screening criteria nowadays? What is its main objective?
7.1. Its goal is to diagnose keratoconus before the signs appear to avoid keratectasia iatrogenic. Double click the image
8. how is ephithelial tickness map going to help?
8.1. Prototype to develop accurate measurements between interfaces. 3D &multi-meridionally scans to produce maps of each layer Double click the image
8.2. Early scans showing pre and post Lasik, allowing to see the micro anatomy of Lasik and to correlate this to clinical outcomes. Double click the image
8.3. Using the analytic signal magnitude, it was possible to detect each surface within the cornea Double click the image
9. What is the 12 map or C12?
9.1. Analysis of the Lasik procedure, the 1st column shows the preoperative epithelial thickness, 2nd column the postoperative epithelial thickness. The rest of the map is derived (epithelial change map). Double click the image
9.2. The resolution of the ultrasound and the oct. Preoperative corneas Double click the image
9.2.1. The resolution of the ultrasound and the oct. Postoperative corneas Double click the image
10. As a result, which is the bias in epithelial thickness between virgin corneas vs Lasik corneas
10.1. After surgery, there is a change in the cornea. These measurements are close between the two devices but they are not a hundred percent exchangeable. Double click the image
11. What is the normal thickness profile?
11.1. The first publication in vivo Double click the image
11.1.1. average epithelial thickness profile plotted. Double click the image
11.1.2. Rigidity of the lid. Double click the image
11.1.3. Stability of the epithelial. Double click the image
12. What is the epithelial thickness profile of the keratoconic cornea
12.1. Paper presentation: Capacity to detect earlier signs of changes in the epithelial Double click the image
12.1.1. Double click the image
12.1.2. Epithelial thickness Normal vs Keratoconus. Double click the image
12.1.3. OCT Epithelial thickness Normal vs Keratoconus. Double click the image
12.1.4. The epithelial goes thinner over the steeper part of the cones. Double click the image
12.1.4.1. The epithelial responds to the rate of curvature of the stromal surface. Double click the image
13. What is the Theory of Early Keratoconus?
13.1. In the early stages, the stromal surface topography is masked by anterior surface topography. Only the back surface indicates if there is a keratoconic process developing Double click the image
14. Why it is a bonus point to measure the epithelial pre-op?
14.1. You can find corneas that have inferior steepening on topography but they do not have keratoconus, simply by looking at the epithelial thickness profile
15. Are these topographies keratoconus?
15.1. 1 .Double click the image
15.1.1. Case 1. Double click the image
15.1.2. Case 2. Double click the image
15.1.3. Case 1. Double click the image
15.2. 2 Abnormal topography, high corneal thickness.
15.2.1. BUT HAS A NORMAL epithelial thickness map. Double click the
15.3. 3 Thicker epithelial. Double click the image
16. What were the results of the evaluation of the "Epithelial thickness Theory"
16.1. Paper presentation. Double click the Image
16.1.1. From a sample of 1532 myopic eyes taken consecutively, 9% (136) were suspected of keratoconus. After VHF, 22 were confirmed with keratoconus. Of the remaining 114, 90 Lasik and 24 PRK, due to other diagnostic reasons. Double click the Image
16.1.2. 90 Keratoconus suspected eyes that went through Lasik, were compared to a matched sample of 90 performed Lasik Double click the Image
16.1.3. Double click the Image
16.1.3.1. No statistically significant difference in spherical equivalent. Double click the Image
16.1.4. No difference in safety. Double click the Image
16.1.5. no difference between the groups after three months. Double click the Image
17. How to avoid False Negatives?
17.1. 6 examples to avoid False-negative. The epithelial thickness mapping showed stromal cones (donut pattern) These were all normal by the algorithms and would have produce Ectasia, ("the ectasia without a cause"). Double click the Image
18. How to avoid False Positives?
18.1. examples to avoid False Positives. The epithelial thickness profile proves that these are all normal corneas. Double click the Image
19. Was an automated algorithm designed based on epithelial thickness profile?
19.1. Paper Presentation. Selected 180 parameters related to epithelial to profiles to create a model. Double click the Image
19.1.1. Complete separation of normal and keratoconic eyes using just the epithelial thickness, not the topography. Double click the Image