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Evaluation of agreement in corneal thickness measurements obtained using optical coherence tomography and ultrasound technique and determination of its specificity in keratoconus screening

The aims of the present study are 1) to evaluate inter and intra observer repeatability of optical coherence tomography corneal thickness measurements 2) to investigate the agreement in corneal thickness obtained using an ultrasound pachymeter and the non-contact high resolution optical coherence tomography 3) to evaluate the false positive rate of identifying keratoconic suspects on the basis of standard machine protocol. Measurements were performed on 51 eyes of 51 individuals without any known corneal pathology. Altman and Bland plots were analyzed to determine agreement of corneal thickness measurements obtained using optical coherence tomography and ultrasound pachymeter; linear regression analysis was performed to evaluate its interchangeability. The agreement between the optical coherence tomography and ultrasonic pachymeter measurements was best for the central corneal thickness with a mean bias of 13.4 microns, with optical coherence tomography values being lower than the ultrasound pachymeter. The agreement of measurements in the mid-peripheral cornea was poor, with bias in measurements ranging from 33 to 55 microns. The optical coherence tomography measurements were repeatable with no differences in values between intra and inter observer repeat measurements. Using standard machine protocol for keratoconus screening, utilizing 1 out of 4 criteria gave a specificity of 86% and using 2 of the 4 criteria gave a specificity of 98%.