Larger Corneoscleral Junction Angle May Predict Milder Keratoconus

Beyond the cornea itself, keratoconus appears to cause significant alterations in corneoscleral architecture, as observed in this small study. Photo: Ruan W, et al. Transl Vis Sci Technol. 2026;15(1):15. Click image to enlarge. Localized corneal alterations in keratoconus are well-documented, but less understood is the effect of the disease on surrounding anatomy, such as the peripheral cornea, scleral limbus, anterior sclera and posterior ocular structures. A recent study observed several differences in corneoscleral morphology on anterior segment OCT between eyes with keratoconus vs. those without the condition. The findings, published in Translational Vision Science & Technology, are detailed below.The study employed a cross-sectional design that compared corneoscleral architecture between 43 eyes with keratoconus and 74 age-matched control eyes. Anterior segment OCT was used to measure corneal and scleral curvatures at distances of 5mm and 2.5mm from the scleral spur. The researchers used the Pentacam system to conduct corneal tomography and analyzed corneal biomechanics with the Corvis ST device.Eyes with keratoconus exhibited greater vertical asymmetry in both scleral and corneal curvature measurements. Notably, a larger superior corneoscleral junction angle correlated with a more favorable profile regarding corneal tomographic and biomechanical parameters, including lower maximum keratometry and a decreased keratoconus classification grade.“The significant association between a larger superior corneoscleral junction angle and a milder corneal phenotype exclusively in the keratoconus group underscores the potential functional importance of the corneoscleral junction architecture,” the researchers wrote in their paper. They explained that this hypothesis is supported by the anatomy of this region, where “a more obtuse angle at this junction may facilitate a smoother, more gradual transition of biomechanical stress between the two tissues,” which, in turn, “could enhance the efficiency of stress redistribution, reduce focal stress concentrations at the limbus and potentially mitigate the ectatic process.”A prominent limitation of this study is its small sample size, especially among the subset of eyes with severe keratoconus. Therefore, the authors suggested, “Future larger cohorts are needed to validate our findings and enable more granular, severity-stratified analyses.” Click here for the journal source. Ruan W, Zhu X, Li M, et al. Corneoscleral morphology in keratoconus and its association with corneal tomography and biomechanics. Transl Vis Sci Technol. 2026;15(1):15. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.