PHOTODOCUMENTATION OF CORNEAL SCARRING

PURPOSE: A standardized system for photodocumenting corneal scars and for evaluating these photographs does not exist and is essential for c linical research, To address this need, we developed a system for phot ographing and evaluating corneal scars. METHODS: In the ''Development Phase,'' we tested several procedures in small samples totaling 40 eye s of 20 keratoconus patients. In the ''Test Phase,'' we used an indepe ndent sample of 150 eyes of 82 keratoconus patients, Fifty-nine of the se 150 eyes had corneal scars, and 91 of the eyes did not as determine d by the clinician. RESULTS: The photography protocol requires four ce ntral parallelepiped and two whole cornea oblique photographs after pu pil dilation. With the clinician as gold standard, this technique yiel ded sensitivity of 96% and specificity of 83%. Evaluation of the corne al photographs as to the presence or absence of corneal scarring was p erformed independently by two masked readers. Agreement between clinic ians on the presence of corneal scarring was 0.99 (kappa); agreement b etween readers for the presence of scarring was 0.80 (kappa), CONCLUSI ONS: The corneal photography protocol we describe is recommended for u se in clinical investigations of cicatricizing corneal disease and app ears robust enough to be used in multicenter studies.