CORNEAL TOPOGRAPHY

INTRODUCTION

• Topography is the science of describing or

representing the features of a particular surface.
• The most widely used technique to assess corneal
shape employs the reflection of a target object
from the anterior corneal surface with convex
mirror optical principles.
 CORNEAL TOPOGRAPHY CONCEPTS

a) Normal corneas
b) Toric corneas
c) KC/PMD
d) Post refractive surgery
e) Orthokeratology
 KERATOSCOPY METHOD
Detailed examination of cornea based on
placido disk.
1.PLACIDO DISK
PLACIDO DISK
PLACIDO DISK
 2. PHOTO KERATOSCOPY

 Earlier method

 Anterior cornea only

 Fails to detect posterior portion

o Photokeratoscopy preserves the virtual image of
concentric circles on film
o Gullstrand developed the first photo-keratoscope in
1966, which opened the way for mathematical analysis,
and developed algorithms to derive quantitative data
from careful measurements of the Placido ring images
o Extracting quantitative data for most of the corneal
surface was important, but the process was too tedious to
be clinically useful
KLIEN KERATOSCOPE
 Self illuminated placido disk
 Central +6D lens to visualize at 9cm.
VON LOEHNAN KERATOSCOPE
CORNEASCOPE
NORMAL
CORNEA

KERATOCONIC
CORNEA
Photokeratoscopy view of early keratoconus
 PHOTOKERATOSCOPIC VIEW OF
ADVANCED KC

NIPPLE SHAPED KC OVAL SHAPED KC GLOBUS SHAPED KC

 3.VIDEOKERATOSCOPY
(CORNEAL TOPOGRAPHY)

 Digitalized computer based.

 Quantitative analysis

 High resolution
 Graphical representation
o Placido studied the corneal surface by observing the reflected
pattern of concentric rings from the cornea: Placido's disk used
since 1870
o Untill recently, keratoscopy instruments provided only a
qualitative assessment of the cornea. In general, the reflected
mires appear closer together on steeper parts of the cornea
o These devices allow analysis of corneal cur-vature in zones
both central and peripheral to those measured by keratometry
o Videokeratoscopy stores the reflected corneal mires on video
o Modern computerized videokeratoscopes evaluate several
thousand points from nearly the entire corneal surface
o Advances in video-image processing and microcomputer
technology provided a means for immediate acquisition and
rapid analysis of the large volume of data
o Color topographic maps have become the standard for
displaying the output of videokeratoscopes since 1987.
CORNEAL CONTOUR DISPLAY
 Currently, the preferred method of displaying the corneal
topography by videokeratoscopy is the topographic map.
 This method provides a large amount of information about the
corneal contour in a single display.
 The corneal topographic map applies the principles of a
geographic topographic map, except that instead of representing
equal elevations, the isometric zones represent equal radii of
curvature.
 The topographic map is derived from the radius
measurements at several thousand corneal positions,
which can be displayed in either millimeters of curvature
or in dioptric power values.
 The diopters that are used for corneal power, however
have only a relative relationship to the true corneal
power in the optical sense.
 COLOR SCALE
• The most useful form of data presentation is a color-coded
corneal contour map in which steep areas are depicted as "hot
colors," such as reds and browns, and shallow areas as "cool
colors," such as blues and greens .
• Two scales are commonly used: absolute and normalized.
• In the absolute scale, Scale range: 9.0D to 101.5 D,
Average value 43D, each color represents a 1.5-diopter
interval between 35 and 50 diopters, whereas above and below
this range, colors represent 5-diopter intervals.
• In the normalized scale, the cornea is divided into 11 equal
colors spanning that eye's total dioptric power.
• In this scale, more minute topographic details within an
individual cornea are appreciated.
• As part of the topographic display, quantitative indices are
also generated, including the following: predicted visual
acuity based on corneal shape, simulated keratometry
readings, minimum keratometry reading, surface regularity
index, and surface asymmetry index, pupil diameter, HVID,
anterior chamber depth, AC volume, Lens details, angle
kappa etc…
 VARIOUS TOPOGRAPHERS

 LSUCTS
 CMS
 COMPUTERISED CORNEAL TOPOGRAPHER EH-270
 EYESYS 2000 CORNEAL ANALYSIS SYSTEM
 TMS (TOMEY) 1,2,3,4
 PAR CORNEAL TOPOGRAPHIC SYSTEM
 CORNEAL LENS ANALYSIS SYSTEM II UNIT
 ORBSCAN
TMS (TOMEY)

TMS-1 TMS-4
HEIGHT MAPS
 Calculated as height of cornea from a
reference plane
 Optically useless but useful for patient
education

DESCRIPTIONS OF CORNEAL TOPOGRAPHY

h d

HEIGHT
HEIGHT FROM
FROM REFERENCE
REFERENCE PLANE
PLANE DEVIATION
DEVIATION FROM
FROM REFERENCE
REFERENCE SPHERE
SPHERE

rS rT

S T

SAGITTAL
SAGITTAL RADIUS
RADIUS TANGENTIAL
TANGENTIAL RADIUS
RADIUS

98900-6S.PPT
ELEVATION MAPS

 Calculates corneal elevation data from a

reference ellipse/sphere

 Surface toricity readily visible

DESCRIPTIONS OF CORNEAL TOPOGRAPHY
h d

HEIGHT
HEIGHT FROM
FROM REFERENCE
REFERENCE PLANE
PLANE DEVIATION
DEVIATION FROM
FROM REFERENCE
REFERENCE SPHERE
SPHERE

rS rT

S T

SAGITTAL
SAGITTAL RADIUS
RADIUS TANGENTIAL
TANGENTIAL RADIUS
RADIUS

98900-6S.PPT
 TOMEY TMS-4

TECHNICAL SPECIFICATIONS
 Refractive index: 1.3375

 Measurement type: light cone

 Rings: 25 or 31

 Measurement points on each ring: 256

 Minimum ring diameter : 0.46 mm

 Maximum ring diameter: 8.8 mm

ADVANCED TOMEY
USEFUL APPLICATIONS
MAP DISPLAY TYPES
TOPOGRAPHIC
NUMERIC
FOURIER ANALYSIS
3D MODEL
ORBSCAN
KERATOCONUS
 Keratoconus:
Central corneal thickness 0.28mm

3-D illustration of corneal shape and thickness extremely valuable for explaining to the
patients what the problem of their eyes are.
PENTACAM
EYE SYS
HUMPHERY
ALCON
MAGELLAN
VIDEOKERATOSCOPIC VIEW OF ADVANCED KC

NIPPLE CONE OVAL CONE GLOBUS CONE

PATIENT

 a) Seat comfortably
 b) Firmly against forehead rest
 c) Steady & fixating at target
TOPOGRAPHY CONSIDERATIONS

 Avoid ring distortion by having the patient blink

 Use a low viscosity artificial tear if necessary
 Lids & Lashes
 Largest fissure possible- reduce eyelash shadows
SINGLE VS MULTIPLE CAPTURES

 Individual captures could have error:

 Movement of the patient
 Variation in tear film thickness

 Take multiple maps (4 is recommended)

 Review the Maps Simultaneously - Look for
Symmetry Between Captures
 Look for Obvious Error
NORMAL CORNEA
REGULAR ASTIGMATISM
IRREGULAR ASTIGMATISM
KERATOCONUS
THANK YOU