Vertical D. A Novel Topographic Pattern in Some Keratoconus Suspects

Purpose: To describe a novel topographic curvature pattern, vertical D, which was present in some keratoconus suspects. This pattern was detected retrospectively in 2 patients who developed post-LASIK ectasia and prospectively in 4 patients who had other corneal abnormalities suggestive of keratoconus. Design: Retrospective interventional case series and prospective cross-sectional study. Participants: After vertical D topographic curvature patterns were noted in 2 patients (3 eyes) who developed post-LASIK ectasia, 1168 consecutive potential refractive surgical candidates (2336 eyes) evaluated at a refractive center were screened to detect this vertical D pattern. Methods: Placido disc-based curvature topography, ultrasound pachymetry, and elevation-based Scheimpflug topography were performed on these patients. Main Outcome Measures: Corneal curvature topographic patterns, central keratometry, inferior-superior and nasal-temporal ratios, skewed radial axis value, Humphrey Atlas PathFinder corneal analysis, corneal thickness, and corneal anterior and posterior elevation. Results: Four additional patients (7 eyes) with vertical D patterns were found (prevalence, 0.34%). In addition to this vertical D pattern, these patients had central corneal thickness < 500 μm and/or posterior corneal protrusion > 20 μm or positive results on keratoconus detection analyses. The 10 eyes with the vertical D pattern had more horizontal (nasal-temporal ratio) than vertical (inferior-superior ratio) curvature asymmetry: 0.98±0.04 diopters versus 0.44±0.2 diopters (paired t test, P<0.001). Conclusions: We propose that vertical D is a novel corneal curvature pattern reflecting horizontal asymmetry that was present in keratoconus suspect patients even if standard keratoconus analyses' results were negative.