Definition

Corneal topography can be defined as the

measurement of corneal shape.

This has been done in some form for

Corneal Topography

Normal corneal shape

Aspheric surface which

flattens towards the

periphery.
i.e. Prolate ellipse.
Rate of flattening
varies for individuals.
Usually possible to find
2 axes of symmetry.

centuries.
Modern systems allow an enormous
amount of information to be collected
about the cornea.

Why measure corneal

shape?
Establishing models of normal corneal shape.
Screening for abnormalities.
Measuring the shape for different applications:
Standard contact lens fitting.
Ortho K
Refractive surgery.

Assessing change over time.

Traditional methods
Traditionally

measured with a
keratometer.
keratometer.
Measures the central
3mm.
Known as the
corneal cap
cap.
Corneal cap assumed
to have a spherospherocylindrical shape.

Does keratometry meet

our aims?
Measuring the shape for different applications?
Standard contact lens fitting?
Not bad but problems if patient is abnormal
abnormal
Ortho K?
No, need peripheral measurements for lens design.
Refractive surgery?
No, no information about what will be needed in the
periphery.

Assessing shape over time?

Not possible for peripheral shape changes which are often

Does keratometry meet

our aims?
Establish model of

normal corneal shape?

No, only measures
centre and assumes it
is spherical.

Screening for

abnormalities?
Not particularly well,
e.g. early keratoconus
etc.

Modern Methods
Projection technique
Used mainly by ophthalmologists
particularly in refractive surgery.

Reflection technique
Most common type in use in optometric
practice.

just as important as central changes.

Projection systems
Expensive
Not widely used in

Ortho K
Do allow anterior and
posterior curvature
maps.
Also possible to
measure corneal
thickness.

Reflection
Videokeratoscopy
Mires close together = steep cornea

Reflection
Videokeratoscopy
Placido mires are

reflected onto the

cornea.
Video image of the
reflection is
analysed.

Reflection
Videokeratoscopy
Mires far apart = flatter cornea

Coloured maps
Coloured map is

generated.
Warmer colours =
steeper cornea
Cooler colours =
flatter cornea
Normal shape is
warmer colours in the
centre and cooler
colours in the
periphery.

Reflection
Videokeratoscopy
Different design principles:
Large cone v small cone.
Large cone:
Comfortable working
distance for practitioner &
patient.
Loss of information as
nose & brow in the way.
Larger instrument.

Limitations of using
reflection
Important to remember that you are not
directly measuring corneal shape

Actually measuring tear film shape over

the cornea.
Therefore affected by dry eye, staining, air
con, fluorescein etc.

Reflection
Videokeratoscopy
Different design principles:
Large cone v small cone.
Small cone:
Smaller instrument.
Minimal loss of
information due to
nose & brow.
More invasive.

Axial, tangential
or height?
There are 3 basic methods of calculating
the corneal shape.
Axial
Tangential
Height

Each has different advantages and

disadvantages.

Tangential maps
Tangential maps

calculate the curvature at

each point with respect to
its neighbouring points.
As it is not biased to an
artificial spherical axis it is
more accurate in the
periphery and can show
localised irregularities.

Axial Maps
Axial maps are based on
a spherically biased
algorithm.
Are good at simulating
the refractive power of
the corneal cap
cap.
However as the cornea
becomes increasingly
aspheric towards the
periphery, axial maps do
not represent the
curvature effectively.

Height maps
Topographical

maps of the earth

use contours of
height above sea
level.
Cannot use an
absolute for the
cornea.

Axial, tangential
or height?

Height maps
For the cornea the

height is calculated
from a reference
sphere.

Axial used to determine whether eye is normal

normal
and potential VA.

Tangential more useful in looking for peripheral

irregularities or determining position of OK

lenses.
Height data is often used to transmit data via
manufacturer software.
So we often use all of them for the same
patient.

Difference maps

Difference maps

Difference maps are used to show the difference

in topography from one measurement to

another.
Used to assess the progression in various
corneal conditions such as keratoconus.
keratoconus.
Also used to determine the change in the cornea
following refractive surgery or orthokeratology.
Warmer colours now = steeper, cooler colours
= flatter.
Original map

1 day follow up

Difference between
the two

Different scales
Absolute scale
Same colour is always equal to the same curvature.
Very wide range of curvatures covered.
Will usually represent normal cornea as yellow/green
in centre changing towards blue in the periphery.
Allows comparisons of eyes.

Different scales

Different scales
Relative or normalised scale
Set number of colours are represented on the
map.
Allows detailed analysis of specific areas.
Cannot compare to other eyes if different
relative scales have been chosen.

Different scales

Adjusted scale:
Operator can define a scale that they wish to
use.
Should be used with care.

Patient 1: sim Ks 7.98@101, 8.19@11

Patient 2: sim Ks 6.86@93, 7.02@3

Absolute scale

Different scales

Different scales
Absolute

Patient 1: sim Ks 7.98@101, 8.19@11

Patient 2: sim Ks 6.86@93, 7.02@3

Normalised scale

What to look for

Spherical shape.
Cornea flattens equally
to the periphery in all
meridians.

Normalised

Beware of using normalised maps too soon.

Always assess whether normal on absolute before using
normalised to look for detail.

What to look for

With the rule
astigmatism

bowtie
bowtie shape
Bowtie vertical
Spectacle cyl is
horizontal minus.
Some slight
asymmetry is normal.

What to look for

Against the rule
astigmatism

bowtie
bowtie shape.
Horizontal bowtie
Spectacle cyl is vertical
minus.

What to look for

Pellucid marginal
degeneration.

Often confused with

keratoconus as it has a
similar effect on vision.
Unlike keratoconus the
steepest parts of the
cornea are usually
along the inferior
oblique meridians.

What to look for

Keratoconus

Usually inferior nasal

steepening but not
always.
Always has a flattening
in the opposite
meridian.
Quality of vision will
depend on the
regularity within the
pupil.

Corneal topography and

contact lenses
Screening and pre assessment.
Choosing a design.
Calculating lens parameters.
Fitting unusual designs and unusual
corneas.

Screening &
Pre assessment
Pre screen patients for:
Keratoconus.
Warpage.
Warpage.
Assess shape after refractive surgery.
Other corneal irregularities.

Choosing a design
Spherical

RGP design

Choosing a design
Patient 1
Corneal cyl
of 2.00D
Do we need
a toric RGP?
Can assess
by eye or
could use
fluorescein
simulation.

Choosing a design
Toric RGP

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Calculating parameters

Calculating parameters

Traditionally done by taking readings at

set positions and calculating design.

Time consuming.
Now software programs can do this

automatically for you and even create

custom designs.

Calculating parameters
Topography is
transferred to
a software
program and
the patients
prescription is
entered.

Calculating parameters
Software
program
calculates the
parameters
and generates
the simulated
fluorescein
pattern.

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Fitting unusual designs

E.g. Orthokeratology:

Fitting unusual designs

Ortho K
Import topographical data

Topography used to calculate peripheral

curves.
Topography is used to assess the changes in
the cornea post wear.

Fitting unusual designs

Ortho K
Fill in Patients Rx + HVID

Fitting unusual designs

Ortho K
Send data to manufacturer

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Fitting unusual designs

Ortho K
Lab calculates lenses and order

Fitting unusual designs

Ortho K
Assessing the corneal changes post wear

Bulls eye

Smiley face

Frowny Face
Fit of lenses is amended
based on the post wear
topography to improve
the result.

Lateral decentration

Central Islands

Summary
Topography expands our knowledge of
corneal shape.

We can increase our first time success

with contact lenses.

We can fit unusual corneas and unusual
lenses.
We can save time and provide a better
service for our patients.

Thank you for listening

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