Enhanced Ectasia Susceptibility Score
Purpose
To test and further refine a combined function to accurately identify ectasia risk (susceptibility) prior to LASIK using clinical and corneal tomography data.
Methods
The “Enhanced Ectasia Susceptibility Score”(EESS) is a combined function designed to enhance accuracy in detecting ectasia risk. In the first studies, the EESS was developed based on clinical and Pentacam data from 266 eyes (141 patients) with stable LASIK outcomes (minimal follow-up of 24 months) and 22 eyes that developed ectasia. Current study further refines and validates the sensitivity in a larger population comprised of 60 eyes from 46 patients that developed ectasia (Group 1). Same stable LASIK group as control (Group 2). The classic Ectasia Risk Score System (ERSS) was calculated for each case.
Results
Statistical differences were found among the groups for many parameters (p<0.001). ERSS was equal or higher than 3 on 36 eyes from the ectasia group (sensitivity = 60%) and on 48 eyes from the stable group (specificity = 81.95%). The mostly accurate single parameter to distinguish between the groups was the BAD-D (sensitivity = 85%; specificity = 83.83%; AUC = 0.925). The EESS obtained 100% of sensitivity, 94.74% of specificity (AUC of 0.995) to distinguish post-LASIK ectasia cases from stable LASIK cases. EESS was statistically better in pairwise comparisons of ROC Curves by DeLong´s Method than all parameters, including BAD-D.
Conclusion
Artificial intelligence strategies should be considered to optimize accuracy in diagnosis, using conscious and validated combinations of parameters. The EESS represents a significant improvement for detecting ectasia risk prior to LASIK.