Introduction

Corneal pachymetry is the process of measuring the thickness of the cornea. A pachymeter is a medical device used to measure the thickness of the eye's cornea. It is used to perform corneal pachymetry prior to refractive surgery, for Keratoconus screening, LRI surgery and is useful in screening for patients suspected of developing glaucoma among other uses.

Corneal thickness as measured by pachymetry is important in the eye care field for several reasons. Pachymetry can tell doctors if the cornea is swollen. Medical conditions such as Fuch's Dystrophy can increase fluid in the cornea and cause an increase in overall thickness.1 Even wearing contact lenses can sometimes cause significant corneal swelling.2 This may be difficult to see under the microscope. However, pachymetry will show a definite increase in thickness.

Importance of corneal thickness

Corneal thickness is important because it can mask an accurate reading of eye pressure, causing doctors to treat you for a condition that may not really exist or to treat you unnecessarily when are normal. Actual IOP may be underestimated in patients with thinner CCT, and overestimated in patients with thicker CCT.

This may be important to your diagnosis; some people originally diagnosed with normal tension glaucoma may in fact be more accurately treated as having regular glaucoma; others diagnosed with ocular hypertension may be better treated as normal based on accurate CCT measurement. In light of this discovery, it is important to have your eyes checked regularly and to make sure your doctor takes your CCT into account for diagnosis.

Corneal pachymetry is the measurement of corneal thickness. Pachymetry was traditionally used to gauge the functional status of the corneal endothelial cell layer. More recently, with the emergence of refractive surgical techniques, corneal pachymetry is necessary to determine suitable candidates for ablation procedures. Furthermore, the identification of central corneal thickness (CCT) as an independent indicator of glaucoma risk by the Ocular Hypertensive Treatment Study (OHTS) has made corneal pachymetry a routine part of the ophthalmic evaluation. Pachymetry is an important part of the evaluation and management of ocular hypertension and glaucoma.

Several techniques are available to reliably and reproducibly measure corneal thickness. The methodologies used in these techniques are based on either ultrasonic or optical principles. While each of the methods have a peculiarity of their own, all have been described as reliable. Keep in mind that systematic differences exist between the different techniques and result in different values. As a result, the measurements cannot simply be substituted between the different modalities.

Process

It can be done using either ultrasonic or optical methods. The contact methods, such as ultrasound and optical such as confocal microscopy (CONFOSCAN), or noncontact methods such as optical biometry with a single Scheimpflug camera (such as SIRIUS or PENTACAM), or a Dual Scheimpflug camera (such as GALILEI), or Optical Coherence Tomography (OCT, such as Visante) and online Optical Coherence Pachymetry (OCP, such as ORBSCAN). Corneal Pachymetry is essential prior to a refractive surgery procedure for ensuring sufficient corneal thickness to prevent abnormal bulging of the cornea, a side effect known as ectasia.

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