Role of Corneal Screening in Pediatric Patients With Allergic Rhinoconjunctivitis: A Proactive Approach to Preventive Ophthalmology: Initial Report of the CATCH (Capturing Atopic Children) Keratoconus Study Group

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PURPOSE: To characterize corneal tomographic and imaging findings in children with allergic rhinoconjunctivitis (AR) and examine their correlation with the severity of ocular allergic signs and symptoms. METHODS: Children diagnosed with AR by pediatric allergists were referred for ophthalmologic evaluation, including corneal tomography (Pentacam, MS-39 AS-OCT) and biomechanical analysis (Corvis ST), in this prospective cross-sectional study. The severity of allergic symptoms was assessed with the rhinoconjunctivitis total symptom score, whereas the intensity of conjunctival papillary reaction was graded clinically. RESULTS: Suspicious or abnormal anterior corneal elevation (Df) was detected in 20.7% of 804 eyes evaluated from 402 pediatric cases with AR; keratoconus was diagnosed in 3 eyes of 2 patients (0.5%). A significant positive correlation was found between Df values and both severity of papillary reaction and rhinoconjunctivitis total symptom score (all P < 0.001). Patients were classified into 2 groups based on Df values. Those with a Df value within the normal range (≤1.6) were classified as group 1, whereas those with abnormal Df values (>1.6) were classified as group 2. Group 2 showed significantly increased epithelial thickness ( P < 0.001) and anterior corneal aberrations compared with group 1, whereas no significant differences were observed in corneal biomechanical indices ( P > 0.05 for all). CONCLUSIONS: Children with AR may exhibit early corneal alterations, particularly in anterior elevation, together with increased epithelial thickness and anterior aberrations. Incorporating corneal imaging into routine evaluation of symptomatic pediatric patients with AR could enable early detection of subtle tomographic and aberrometric abnormalities, underscoring the importance of preventive ophthalmologic screening within pediatric allergy care.