AvaGen Genetic Testing versus Ocular Screening Assessments Including the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS) in Refractive Surgery Candidates

Figures & data

Table 1 KSS, ERSS, and Combined Criteria

	KSS Criteria	ERSS Criteria	Combined Criteria
Low	0 to 1 pts.	0 to 2 pts.	0 to 3 pts.
Moderate	2 to 3 pts.	3 pts.	4 to 7 pts.
High	4 to 5 pts.	4 to 10 pts.	8 to 15 pts.

Figure 1 AG Risk Scoring Categorization.

Table 2 Basic Demographic, Criteria Categorization, AvaGen Score, and Recommendations for Study Eyes

Category	Patient No./ Sex/ Age	Indices/ Family Hx: Condition [Relative(s)]	Eye	KSS Criteria	Randleman Criteria	Combined Criteria	AvaGen	Recommendation
GLS	1/F/20	KC [U]	OD	Low (0)	High (5)	Moderate	Moderate Moderate (53)	Reevaluate for PRK in 1 year
			OS	Moderate (2)	High (8)	High
	2/F/38	KC [F]	OD	Moderate (2)	High (6)	High	Moderate Moderate (45)	Reevaluate for PRK in 1 year
			OS	Moderate (2)	High (6)	High
	3/F/31	Cataracts [GM, A]	OD	Moderate (2)	Moderate (3)	Moderate	Low Moderate (39)	Recommend PRK
			OS	Moderate (2)	Moderate (3)	Moderate
GES	4/M/32	Astigmatism [F]	OD	Moderate (2)	Moderate (3)	Moderate	Moderate Moderate (45)	Received PRK
			OS	Moderate (2)	Moderate (3)	Moderate
	5/M/30	KC [A]	OD	Moderate (2)	Moderate (3)	Moderate	Moderate Moderate (51)	Reevaluate for PRK in 1 year
			OS	Moderate (2)	Moderate (3)	Moderate
	6/F/24	KC [B]	OD	Low (1)	High (6)	Moderate	Moderate Moderate (51)	Reevaluate for PRK in 1 year
			OS	Low (1)	High (6)	Moderate
GHS	7/M/37	KC [M]	OD	Low (0)	Low (2)	Low	High moderate (57)	No refractive surgery
			OS	Low (1)	Moderate (3)	Moderate
	8/F/38	Cataracts [NOS]	OD	Moderate (3)	High (4)	Moderate	High moderate (63)	Reevaluate for PRK in 1 year
			OS	Moderate (3)	High (4)	Moderate
	9/F/44	Astigmatism [F]	OD	Moderate (2)	Moderate (3)	Moderate	High moderate (58)	Recommend PRK
			OS	Moderate (2)	Moderate (3)	Moderate
	10/M/25	KC predisposition [M]	OD	Low (0)	Low (2)	Low	Low moderate (38)	Reevaluate PRK/ LASIK/ SMILE in 5 years
			OS	Low (0)	Low (2)	Low
	11/F/35	KC [NOS]	OD	Low (0)	Low (0)	Low	High (69)	Reevaluate for PRK in 1 year
			OS	Low (1)	Low (0)	Low
	12/M/36	KC [U]	OD	Low (1)	Low (0)	Low	High (72)	Recommend PRK
			OS	Low (1)	Low (0)	Low
	13/M/30	KC [F, A, U]	OD	Low (0)	Low (0)	Low	High Moderate (62)	No refractive surgery
			OS	Low (0)	Low (2)	Low
	14/F/46	KC [S]	OD	Low (0)	Moderate (3)	Low	Moderate Moderate (51)	Received PRK
			OS	Low (0)	Moderate (3)	Low
	15/M/24	KC [F]	OD	Low (1)	Low (2)	Low	Low Moderate (42)	No refractive surgery
			OS	Low (1)	Low (2)	Low
	16/M/21	KC [M, B]	OD	Low (1)	Moderate (3)	Low	High (71)	Reevaluate PRK in 5 years
			OS	Low (1)	Moderate (3)	Low
	17/M/23	KC [F, S]	OD	Low (0)	Low (2)	Low	Moderate Moderate (52)	Reevaluate PRK in 1 year
			OS	Low (0)	Low (2)	Low
	18/F/45	Fuchs’ dystrophy [M]	OD	Moderate (2)	Moderate (3)	Moderate	High (79)	Reevaluate PRK in 5 years
			OS	Moderate (2)	Moderate (3)	Moderate
	19/M/44	KC predisposition [NOS]	OD	Low (1)	Low (1)	Low	High (79)	Reevaluate PRK in 5 years
			OS	Moderate (2)	Moderate (3)	Moderate

Abbreviations: Aunt [A], Brother [B], Father [F], Grandmother [GM], Mother [M], Not Otherwise Specified [NOS], Sister [S], Uncle [U].

Table 3 Average Measurement of Age and AG Scoring Between Categories (n = 19 Eyes)

Parameter (Mean ± SD)	GLS	GES	GHS	Total
	(n = 3)	(n = 3)	(n = 13)	(n = 19)
Age (years)	34.46 ± 9	28.67 ± 4.2	29.67 ± 9.1	32.79 ± 8.48
AG Score	45.7 ± 7.0	49.0 ± 3.46	61.0 ± 13.0	57.0 ± 13.1

Figure 2 AvaGen Distribution Amongst Patient Cohort.

Figure 3 Depiction of Combined Criteria scoring against AvaGen scoring.

Figure 4 KC Risk Gene Distribution for Patient Cohort.

Figure 5 Comparison of KC Risk Genes Across Avagen Groups.

Figure 6 Depiction of Topographic Indices Between the Three Categories (GLS, GES, and GHS). Cut-off values for detecting KC were represented with a horizontal line for each measurement.

Abbreviations: GLS, genetic lower than screening; GES, genetic equal to screening; GHS, genetic higher than screening; ISV, index of surface variance; IVA, index of vertical asymmetry; IHD, index of height decentration; ARTmax, maximum Ambrosio relational thickness; PPI-max, pachymetric progression index maximum; BAD-D, Belin/Ambrósio enhanced ectasia deviation.