Comment on Advantages of Anterior Segment Optical Coherence Tomography Evaluation of the Kayser–Fleischer Ring in Wilson Disease

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To the Editor:
We read with great interest the case series by Sridhar1 in which the author used anterior optical coherence tomography imaging to detect Kayser–Fleischer rings (KFRs) in 7 patients. In the study, the author measured on the images how far centrally the KFR extended. The author mentions that another way to use the technique is by measuring the density of KFRs. We would therefore like to make the author aware of our previously published article2 in which we use a different anterior segment imaging modality, Scheimpflug imaging, to visualize KFRs and analyze the signal density of the rings. In our study comprising 21 patients with Wilson disease (11 with a KFR) and a control group of healthy volunteers, we could successfully visualize the KFR in all patients. Discriminating between a faint KFR and artifacts was in some cases challenging. We therefore analyzed the subendothelial signal density and normalized it to the epithelial signal. The signal density ratio showed high sensitivity and specificity in diagnosing KFRs. Based on our previous study and the recently published study by Sridhar, we can conclude that anterior segment imaging, using either optical coherence tomography or Scheimpflug, is a valuable ancillary tool for diagnosing KFRs. Given the rarity of the disease, this applies specially to smaller centers with less experience with these patients. Future studies will determine its use in monitoring the disease.
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