Abnormal Corvis Biomechanical Indices in Pediatric Hyperopia: Keratoconus or Age-Related Elasticity?

Purpose To investigate whether abnormal Corvis ST biomechanical indices (CBI, TBI) in pediatric hyperopic eyes (0–17 years) reflect early keratoconus or normal age-related corneal elasticity. Methods A retrospective cross-sectional study was conducted on 139 pediatric patients (277 eyes) at Advanced Eye Care Hospital in Lebanon who underwent corneal biomechanical assessment with the Corvis ST. Inclusion criteria were age 0–17 years with hyperopic or emmetropic refraction; myopic eyes were excluded. “Abnormal” indices were defined as CBI ≥ 0.50 and TBI ≥ 0.79 (≥ 0.29 considered suspicious). Proportions of eyes exceeding thresholds were calculated and correlated with clinical and tomographic findings. Results Nearly half of eyes (124/274; 45%) had CBI ≥ 0.50, and 22% exceeded CBI ≥ 0.90. Among 39 eyes with integrated tomography, 33% had TBI ≥ 0.79 and 85% exceeded 0.29. Despite these high rates of “abnormal” biomechanical indices, no eyes (except one with very thin cornea, 376 µm) demonstrated clinical or tomographic signs of keratoconus. Conclusions and Importance Using adult thresholds, Corvis ST flags a large proportion of normal pediatric hyperopic corneas as abnormal, suggesting high false-positive rates in children. These findings indicate that elevated CBI/TBI in pediatric hyperopes likely reflect normal physiologic elasticity rather than keratoconus. Pediatric-specific cutoff values or age-adjusted norms are needed to improve diagnostic accuracy and avoid over-diagnosis.