Corneal Topography

CORNEAL TOPOGRAPHY
 The word topography derived from Greek word : ‘topos’

(place) and ‘graphein’ (to draw)
 Corneal topography corresponds to the graphic

representation of the geometrical properties of corneal
surface
 Tomography
Derived from Greek word : Tomos (slice/

section) and grapho (to write )
ASSESSMENT OF CORNEA
Background
• In 1619 Father Christopher Scheiner

realized that one could estimate
corneal curvature by comparing the
reflection of a window on the corneal surface to that on a series
of different sized marbles.
• Placidos disc
• Corneal astigmatism – not quantified
• Absence of central mire reflection
• Anatomy of nose & orbit may limit field size
• Keratometer
• Assumes that the cornea is symmetrical
• Measures only a small region centrally& peripheral
regions are ignored
• Loses accuracy when measuring very flat or very
steep corneas (> 50 D)
• Not good for refractive procedures
Corneal topography
• Also known as videokeratography
• This is the method by which the surface curvature

of the cornea is mapped
• Provides detailed description of the shape & power

of the cornea
• Gives quantitative measurement of the whole of

cornea
05/13/2020 CORNEAL TOPOGRAPHY 15

Clinical Application
• Detection of corneal pathologic conditions
(keratoconus, PMD)
• Detecting & evaluating the severity of keratoconus
• Screening tool before refractive surgery
• Evaluation of irregular astigmatism especially after PK
• Evaluation of the effects of corneal refractive surgery
• Helps in planning of suture removal & post operative fitting of

contact lens

Working of Videokeratograph
• Multiple light concentric rings are projected on

the cornea
• The reflected image is captured on CCD

camera.
• Computer software analyses the thousands

of data points captured and displays the
results in the form of topography map.

Raw Data - Normal cornea

Steep and flat cornea

Characteristics of normal cornea
• Flattens from centre to periphery 2-4D
• Topographic pattern- unique to the individual
• The 2 corneas of one individual normally exhibit

nonsuperimposable mirror image symmetry
• Exhibits relative smoothness & absence of

significant astigmatism

Types of Normal corneas
• Usually Prolate – Steep in the center and

flattens towards the periphery
• Types of normal corneal topography:

• Round – 22.6%
• Oval – 20.8%
• Symmetric Bowtie – 17.5%
• Asymmetric Bowtie – 32.1%
• Irregular – 7.1%

Round topography

Oval topography

Symmetric bow tie

Asymmetric bow tie

With the rule astigmatism

Against the rule astigmatism

Interpreting topography maps
• Warm colors- red, orange, yellow- steeper

portions of cornea
• Intermediate- green
• Cool colors- light blue, dark blue - flatter portions

of cornea

ABSOLUTE SCALE

NORMALIZED SCALE

Quantitative descriptors of Topography
• Sim K: Obtained from the greatest or least power meridian in the

cornea, by averaging the measured values of 6-8th rings on the
meridian.
• Sim K1 - It’s the power and axis of the meridian with the
highest power
• Sim K2 : Power of the meridian 90 degrees from Sim K1
• Higher value indicates keratoconus, S/P PK or a normal steep eye.
• Lower than normal values occur with myopic refractive surgery

and rare flat cornea.
• Cyl : Simulated keratometer cylinder is obtained

from difference of Sim K1 & Sim K2 reading

SAI( Surface Asymmetry Index):

– Measured as the difference in corneal powers at every ring
180 degrees apart over the entire corneal surface
– SAI is higher in keratoconus, PK, decentred myopic
refractive surgery, trauma and CL warpage
SRI( Surface Regularity Index):

– Measures local fluctuations in central corneal power.
– High values found in cases of dry eyes, CL wear, trauma ,
PK

• Asphericity (Q) : Asphericity is a measure of the

rate of flattening of the cornea from the apex to
the periphery.
• Allows positive values to describe oblate surfaces and
negative surface for prolate surfaces. Normal Q =-0.26
• Predicted visual acuity (PVA): provide a single

value in units of Snellen acuity of the optical
quality of the corneal surface within the 3 mm
zone ranging from 20/10 – 20/200

Standard deviation of corneal power (SDP):
– This is calculated from the distribution of all the

corneal power present on videokeratography
Differential sector index (DSI)
– Subdivide the cornea into 8 segments
– Maximum difference existing between the mean

of 2 of the 8 segments
• Opposite sector index (OSI):

Cornea divided into 8 segments
• Greatest difference of mean corneal power existing
between 2 opposite sectors
• Keratoconus predictive index (KPI) :is

obtained from statistical analysis of indices. This
is a numerical estimator of keratoconus which
spans from 0, when there are no topographical
characteristics relative to keratoconus these
indices reveal the presence

Analyzed area (AA)
– This value expresses the percentage of corneal

surface covered by the instrument. The value
is low in case of advanced keratoconus,
corneal trauma.

CORNEAL INDICES
INDICES NORMAL ABNORMAL
SAI 0.42 0.50
SRI 1.01 1.97
DSI 2.96 3.51
OSI 1.65 2.09
SDP 1.17 1.33
IAI 0.44 0.49
KPI 0.23 0.30
AA 69.43 73.49

Types of topographic maps
Axial Map –
1. Describes the overall shape of
the cornea
2. Calculates curvature rather

than Power
3. Easy to understand
4. Colours visually represent

flatness and steepness
5. Cannot measure periphery

Tangential map
More sensitive
Calculates corneal curvature

based on a “Tangent to the
normal”
Best to identify corneal

pathologies and localized
defects

Refractive power maps
Accounts for aberration

while calculating power
and radius
Useful in assessing the

visual performance or
the end result of post –
refractive surgeries

Elevation maps
Measures the
difference in height
or elevation of the
cornea in microns
from the reference
surface

Irregularity map
– Similar to the elevation map but
uses the best fit Toric surface
reference
– Quantifies and defines the most

irregular areas of the corneal
surface

Qualitative observation of corneal map
• Absence of data points superiorly may indicate

Blepharochalasis, Ptosis…
• White areas on the map indicate

physiologically dry area or marginal dry eyes
• Distorted areas may indicate pterygiums,

pingueculae, limbal keratitis, tear film debris,
surface irregularities

Keratoscopic errors
• Errors due to misalignment of central mires
• Patient’s misalignment errors and due to poor

fixation
• Misinterpretation errors due to the analysis of

only the absolute or the relative map
• Tear abnormality

ABNORMAL TOPOGRAPHY

Early keratoconus

Moderate keratoconus

Advanced keratoconus

Pellucid marginal degeneration

Terrien’s marginal degeneration

Keratoglobus

Corneal warpage

Post radial keratotomy

Post lasik

Corneal scars

Post pk

Lipid keratopathy

Bullous keratopathy

Pterygium

Decentered contact lens smile
pattern

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Corneal Topography

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CORNEAL TOPOGRAPHY

 The word topography derived from Greek word : ‘topos’

 Corneal topography corresponds to the graphic

Derived from Greek word : Tomos (slice/

• In 1619 Father Christopher Scheiner

• This is the method by which the surface curvature

• Provides detailed description of the shape & power

• Gives quantitative measurement of the whole of

05/13/2020 CORNEAL TOPOGRAPHY 15

• Detecting & evaluating the severity of keratoconus

• Screening tool before refractive surgery

• Evaluation of irregular astigmatism especially after PK

• Evaluation of the effects of corneal refractive surgery

• Helps in planning of suture removal & post operative fitting of

05/13/2020 CORNEAL TOPOGRAPHY 16

• Multiple light concentric rings are projected on

• The reflected image is captured on CCD

• Computer software analyses the thousands

05/13/2020 CORNEAL TOPOGRAPHY 17

05/13/2020 CORNEAL TOPOGRAPHY 18

05/13/2020 CORNEAL TOPOGRAPHY 19

• Topographic pattern- unique to the individual

• The 2 corneas of one individual normally exhibit

• Exhibits relative smoothness & absence of

05/13/2020 CORNEAL TOPOGRAPHY 20

• Usually Prolate – Steep in the center and

• Types of normal corneal topography:

05/13/2020 CORNEAL TOPOGRAPHY 21

05/13/2020 CORNEAL TOPOGRAPHY 23

05/13/2020 CORNEAL TOPOGRAPHY 24

05/13/2020 CORNEAL TOPOGRAPHY 25

05/13/2020 CORNEAL TOPOGRAPHY 26

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05/13/2020 CORNEAL TOPOGRAPHY 28

• Warm colors- red, orange, yellow- steeper

• Cool colors- light blue, dark blue - flatter portions

05/13/2020 CORNEAL TOPOGRAPHY 29

05/13/2020 CORNEAL TOPOGRAPHY 30

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• Sim K: Obtained from the greatest or least power meridian in the

• Higher value indicates keratoconus, S/P PK or a normal steep eye.

• Lower than normal values occur with myopic refractive surgery

• Cyl : Simulated keratometer cylinder is obtained

05/13/2020 CORNEAL TOPOGRAPHY 32

SAI( Surface Asymmetry Index):

SRI( Surface Regularity Index):

05/13/2020 CORNEAL TOPOGRAPHY 34

• Asphericity (Q) : Asphericity is a measure of the

• Predicted visual acuity (PVA): provide a single

05/13/2020 CORNEAL TOPOGRAPHY 35

Standard deviation of corneal power (SDP):

– This is calculated from the distribution of all the

Differential sector index (DSI)

– Subdivide the cornea into 8 segments

– Maximum difference existing between the mean

• Opposite sector index (OSI):

• Keratoconus predictive index (KPI) :is

05/13/2020 CORNEAL TOPOGRAPHY 37

Analyzed area (AA)

– This value expresses the percentage of corneal

05/13/2020 CORNEAL TOPOGRAPHY 38

05/13/2020 CORNEAL TOPOGRAPHY 39

2. Calculates curvature rather