Photodocumentation of corneal scarring

PURPOSE: A standardized system for photodocumenting corneal scars and for evaluating these photographs does not exist and is essential for clinical research. To address this need, we developed a system for photographing and evaluating corneal scars. METHODS: In the 'Development Phase,' we tested several procedures in small samples totaling 40 eyes of 20 keratoconus patients. In the 'Test Phase,' we used an independent sample of 150 eyes of 82 keratoconus patients. Fifty-nine of these 150 eyes had corneal scars, and 91 of the eyes did not as determined by the clinician. RESULTS: The photography protocol requires four central parallelepiped and two whole cornea oblique photographs after pupil dilation. With the clinician as gold standard, this technique yielded sensitivity of 96% and specificity of 83%. Evaluation of the corneal photographs as to the presence or absence of corneal scarring was performed independently by two masked readers. Agreement between clinicians on the presence of corneal scarring was 0.99 (kappa); agreement between readers for the presence of scarring was 0.80 (kappa). CONCLUSIONS: The corneal photography protocol we describe is recommended for use in clinical investigations of cicatricizing corneal disease and appears robust enough to be used in multicenter studies.