Corneal topography

Corneal topography is a non-invasive medical imaging technique for mapping the surface curvature of the cornea, the outer structure of the eye. Since the cornea is responsible for some 70% of the eye's refractive power, its topography is of critical importance in determining the quality of vision. The three-dimensional map produced by corneal topography assists in the diagnosis and treatment of a number of conditions; in the planning of refractive surgery such as LASIK and evaluation of its results; or in assessing the fit of contact lenses. The procedure is carried out with a corneal topographer, a device that projects a series of illuminated rings onto the cornea and captures its image with a digital camera.

Overview

The principle behind corneal topography is relatively simple. It involves the projection of a series of concentric rings onto the cornea, which are reflected back and captured by the topographer's camera. The data collected is then used to construct a topographic map of the cornea. The color-coded map produced by the topographer provides detailed information about the shape and power of the cornea. Different colors are used to denote different elevations and curvatures, which can help in identifying irregular conditions.

Clinical Applications

Corneal topography is utilized in a variety of clinical scenarios:

• Diagnosis and Management of Corneal Diseases: Conditions such as keratoconus, pellucid marginal degeneration, and corneal dystrophies can be diagnosed and monitored using corneal topography.
• Refractive Surgery: It is crucial in planning procedures like LASIK, providing information on corneal thickness and surface characteristics.
• Contact Lens Fitting: Especially useful for fitting specialized contact lenses in patients with irregular corneas, such as those with keratoconus.
• Post-operative Assessment: Used to assess the outcome of corneal surgery and the healing process.

Types of Corneal Topographers

There are several types of corneal topographers, each using different technologies to achieve the mapping:

• Placido Disc Systems: Utilize a series of concentric rings reflected off the cornea.
• Scheimpflug Cameras: Provide three-dimensional images of the cornea, allowing for detailed analysis of the anterior and posterior corneal surfaces.
• Scanning Slit Topography: Uses a scanning slit of light to create a topographic map of the cornea.

Interpreting Corneal Topography

The interpretation of corneal topography maps is complex and requires understanding of the color-coded maps. Typically, cooler colors (blues and greens) represent flatter areas, while warmer colors (reds and oranges) indicate steeper areas. Various patterns can indicate different corneal conditions:

• Inferior Steepening: Often seen in early keratoconus.
• Central Steepening: May indicate a more advanced keratoconus or post-LASIK ectasia.
• Irregular Astigmatism: Can be indicative of corneal scarring or dystrophies.

Limitations

While corneal topography is a powerful tool, it has its limitations. It does not provide information on the cornea's internal structure or thickness, which are important in some diagnostic and treatment decisions. Additionally, the accuracy of the maps can be affected by factors such as eye movement or poor tear film.

Conclusion

Corneal topography is an essential tool in modern ophthalmology, providing valuable information for the diagnosis and treatment of various eye conditions. Its non-invasive nature and detailed output make it an indispensable part of eye care.

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  Corneal topography right axial map

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  Oculus Pentacam corneal eye scan

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  Computerised corneal topography

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  Corneal topography, stage II keratoconus