Determining progression in ectatic corneal disease

Michael W. Belin, Reza Alizadeh, Emilio A. Torres-Netto, Farhad Hafezi, Renato Ambrósio, Bojan Pajic

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations


Before the advent of modern tomographic imaging and corneal cross-linking (CXL), diagnosis and treatment of ectatic disease were limited to disease severity where changes on the anterior corneal surface lead to visual complaints. Rigid contact lenses and/or penetrating keratoplasty addressed late stage disease, as identifying early or subclinical disease was not possible, or its need appreciated. The emergence of CXL as a viable treatment to alter the natural progression of keratoconus heightened the need for improved diagnostics. Several methods have been described in the literature to evaluate and document progression in keratoconus, but there has been no consistent definition of ectasia progression. Newer imaging techniques (ie, tomography) allowed the detection of earlier ectatic disease, before visual loss and subjective complaints. The Belin ABCD classification/staging system was introduced on a Scheimpflug imaging system [Pentacam, (Oculus GmbH, Wetzlar, Germany)] to address previous shortcomings. The ABCD system utilizes 4 parameters: Anterior ("A") and posterior ("B"for Back) radius of curvature taken from a 3.0mm optical zone centered on the thinnest point, "C"is minimal Corneal thickness, and "D"best spectacle Distance visual acuity. The first 3 parameters (A, B, C) are machine-generated objective measurements that can be used to determine progressive change. The staging system is not limited to a specific commercial entity and can be incorporated in any tomographic imaging system. The ABCD Progression Display graphically displays each parameter and shows when statistical change above measurement noise is reached. This should allow the clinician the ability to diagnose progressive disease at a much earlier stage than was previously possible, with the confidence that earlier intervention could prevent visual loss.

Original languageEnglish (US)
Pages (from-to)541-548
Number of pages8
JournalAsia-Pacific Journal of Ophthalmology
Issue number6
StatePublished - Nov 2020


  • Cross-linking
  • Ectatic disease
  • Keratoconus
  • Progression
  • Tomography

ASJC Scopus subject areas

  • Ophthalmology


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