RVEEH Webinar Series – Cornea: Reading the Map: Mastering Corneal Imaging in Clinical Practice.

RVEEH Webinar Series - Cornea: Reading the Map: Mastering Corneal Imaging in Clinical Practice.

Date: 24/08/2026 ()

Venue: Online, AUSTRALIA

Provider: Royal Victorian Eye and Ear Hospital

Contact: Kerryn Baker, [E] medicaleducation@eyeandear.org.au, [P] 03 9929 8528

Activity Outline

This talk brings together corneal topography and multimodal ocular imaging to give clinicians a confident, practical framework for interpretation in everyday practice.

Part 1 — The Foundation: How Corneal Imaging Works We begin with a brief journey through the evolution of corneal assessment — from retinoscopy and keratoscopy to modern topography and tomography. The key distinction between topography (anterior surface only) and tomography (anterior + posterior) is established, along with the two core technologies: Placido disc reflection and Scheimpflug imaging. Understanding how these systems work underpins everything that follows.

Part 2 — Reading the Maps A practical, systematic approach to the major corneal map types: axial, tangential, elevation, and pachymetry. We cover colour scales, key indices (Kmax, ISV, IVA, Q-value), and common pitfalls — including how scale choice can mislead. The 4-map Pentacam display is used as the clinical framework.

Part 3 — Pattern Recognition: Normal, Suspicious, and Pathological Normal symmetry, with-the-rule and against-the-rule astigmatism, and the classic patterns of keratoconus, pellucid marginal degeneration, post-LASIK ectasia, corneal scarring, pterygium, and post-keratoplasty. Emphasis on early detection and differentiating ectasia from other conditions.

Part 4 — Beyond Topography: Anterior Segment OCT and Complementary Imaging The role of AS-OCT in pachymetry, epithelial mapping, angle assessment, and surgical co-management. Brief overview of meibomography, specular microscopy, confocal microscopy, and B-scan ultrasound — when to reach for each.

Part 5 — Clinical Integration and Pearls Multimodal workflows for common clinical scenarios. Practical pearls for acquisition quality, avoiding misinterpretation, and correlating imaging findings with clinical examination.

Learning Objectives

• Explain the principles underlying corneal topography and tomography. Describe the optical principles of Placido disc reflection and Scheimpflug imaging. Distinguish between topography (anterior surface curvature) and tomography (full corneal analysis including posterior surface and pachymetry).
• Systematically interpret the four core corneal map types. Accurately read axial, tangential, elevation, and pachymetry maps. Understand the clinical relevance of each map type — including why tangential maps are more sensitive for early ectasia, and why elevation maps are essential for detecting subtle posterior corneal changes.
• Recognise key topographic indices and their clinical significance. Interpret K1, K2, Kmax, Km, ISV, IVA, and Q-value in the context of patient assessment. Understand the role of posterior corneal values and thinnest-point pachymetry in ectasia screening. Apply these parameters to refractive surgery suitability screening.
• Identify normal and abnormal topographic patterns with confidence. Distinguish normal with-the-rule and against-the-rule astigmatism from pathological patterns. Recognise the characteristic topographic signatures of keratoconus (inferior steepening, skewed radial axes), pellucid marginal degeneration (kissing birds/crab claw pattern), post-LASIK ectasia, corneal scarring, pterygium, and post-keratoplasty irregularity.
• Apply corneal topography in the detection and monitoring of keratoconus. Use serial topographic data to detect early progression and assess treatment response following collagen cross-linking or intracorneal ring segment implantation. Understand the importance of topography in contact lens fitting for irregular corneas, including scleral and orthokeratology lens design.
• Describe the key applications of Anterior Segment OCT (AS-OCT) in clinical practice. Understand how AS-OCT complements topography in corneal assessment — particularly epithelial thickness mapping for early ectasia detection, residual stromal bed measurement post-refractive surgery, and monitoring orthokeratology effect.
• Recognise the role of complementary imaging technologies. Identify when meibomography, specular microscopy, confocal microscopy, and B-scan ultrasonography add diagnostic value. Appreciate the utility of multimodal imaging workflows in common clinical scenarios such as the glaucoma suspect, the dry eye patient, and the refractive surgery candidate.
• Apply a structured, quality-assured approach to image acquisition and interpretation. Identify sources of error in topography acquisition — including poor tear film, patient movement, and misalignment. Avoid common interpretation pitfalls, including scale-dependent artefacts and the overcalling of abnormalities on normalised maps.

Max CPD hours awarded: 1

Session Information