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17 Holladay Report & Holladay EKR65 Detail Report
17.4 Case 2: Holladay Report & Holladay EKR65 Detail Report of a
keratoconus exam
Figure 161: Holladay Report from a keratoconus exam
The axial power map scale is centered at 43.0 D (green), which is normal. The axial and tangential
curvature maps show a "hot spot" with the peak at 8 mm on the axial map and 6 mm on the
tangential map
(Figure
161). The peak is geometrically more accurately located on the tangential
map. The corneal thickness map shows the TP is displaced inferiorly by almost 1 mm, slightly nasally
and is not at the center of the vertical ellipse. A vertical ellipse with the TP inferior is suggestive of
keratoconus. The ellipse may also be egg-shaped in severe cases, with the small end of the ellipse
pointing in the direction of the "hot spot" on the curvature maps. On the RP map the minimum
-4.6% is at the limit of suspicious and is also located at the point of peak power on the tangential
curvature map. The elevation (front) is +9 μm and located at the "hot spot" and minimum of the RP.
The elevation (back) is highly elevated, at 25 μm above the reference BFTEF, and also at the same
location as the peak on the front. It is typical in keratoconus for the back elevation to be higher than
the front, due to epithelial remodeling on the front. The average thickness of the epithelium is
50 μm, and 6 – 8 epithelial cell s thick. The 16 μm higher on the back (25 – 9 μm) indicates that the
epithelium is ~2 cells thinner than normal due to the protrusion and physiologic smoothing of the
surface.
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