Determining the Relationship Between Regional Epithelial Thickness, Corneal Toricity, and Corneal Power in Normal Corneas.

Purpose: To determine the relationship between regional epithelial thickness and corneal toricity and estimate the epithelium's impact on corneal power in normal corneas.

Methods: This was a retrospective case-control study evaluating 200 eyes from 200 patients categorized into one of three groups based on corneal toricity obtained with Scheimpflug imaging: (1) 80 non-toric (NT) eyes (< 0.50 diopters [D] in any meridian), (2) 80 with-the-rule (WTR) eyes (⩾ +1.50 D @90 ± 22.5°), and (3) 40 against-the-rule (ATR) eyes (⩾ +1.50 D @180 ± 22.5°). Epithelial thickness maps (9 mm) were generated using anterior segment optical coherence tomography (ASOCT) imaging (Avanti RTVue XR; Optovue, Inc). Mathematical modeling was used to evaluate the epithelium's impact on corneal power.

Results: There were no differences in mean curvature between groups (range: 43.2 to 43.7 µm). Average epithelial thickness profile within the central 9-mm zone varied by approximately 2 µm or less laterally but was thinner superiorly than inferiorly in all three groups (52.45 to 53.36 vs 56.01 to 56.48 µm) with no significant differences between groups. There were no differences in any measured epithelial metric at any location nor any deviation in overall epithelial thickness pattern between groups. There were minimal average variations (< 4 µm) across the cornea between central and peripheral values in any meridian. The modeled impact on corneal optics was a net reduction in curvature by approximately 0.30 D with less than 0.10 D of possible variation resulting from differences in regional thickness.

Conclusions: Regional epithelial thickness was unrelated to underlying corneal toricity and had minimal impact on corneal power in normal eyes. There was no evidence that normal epithelium significantly masks underlying normal stromal toricity, nor does the epithelium significantly contribute to corneal power under normal conditions. [J Refract Surg. 2025;41(2):e91-e101.].