ORIGINAL RESEARCH article
Front. Bioeng. Biotechnol.
Sec. Biomechanics
Volume 13 - 2025 | doi: 10.3389/fbioe.2025.1598546
Development and Validation of the VAE-NT Index: A Novel Biomechanical Parameter for Distinguishing Subclinical Corneal Abnormalities
Provisionally accepted
- 1Huadong Hospital, Fudan University, Shanghai, China
- 2Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Purpose: To develop an index for distinguishing between VAE-NT (normal topography eyes from patients with very asymmetric ectasia) and normal eyes with good performance in validity, reliability and predictive value.: In the training dataset, this single-center retrospective study involved 102 healthy eyes and 97 VAE-NT eyes. After PSM (Propensity Score Matching), data of 53 healthy eyes and 53 VAE-NT eyes, including demographic and Corvis ST examination results, were collected. The AUC, sensitivity, specificity, ICC, positive and negative likelihood ratios were calculated for the DCR (Dynamic Corneal Response) parameters of Corvis ST. The TOPSIS model was used to objectively and comprehensively evaluate the Corvis ST DCRs, and logistic regression was employed to determine the optimal combination of parameters that can accurately separate VAE-NT from normal corneas. In the validation dataset, 44 VAE-NT eyes and 49 normal eyes were involved. The index's validity, reliability, and predictive value were further assessed using the validation dataset. The VAE-NT index was compared with TBI both in training dataset and validation dataset. Results: In the training dataset, the optimal parameter combination forming the VAE-NT index, including the following DCRs: SP A1, SP HC, A1 Time, DA Ratio Max (2mm), DA Ratio Max (1mm), Integrated Radius, and SSI2. The receiver operating characteristic curve analysis showed an AUC of 0.971 with a cut-off value of 0.425, 95.283% accuracy, 94.340% specificity and 96.230% sensitivity. In validation dataset, the AUC of VAE-NT index was 0.980. The sensitivity and specificity of VAE-NT index were 93.180% and 95.920%, respectively. The positive and negative likelihood ratios of VAE-NT index were 22.830 and 0.071, respectively. The ICC of VAE-NT index was 0.835 and the accuracy is 94.624%. VAE-NT index outperformed TBI on both the training dataset and the validation dataset.The VAE-NT index was developed, exhibiting high sensitivity, specificity and AUC, and favorable likelihood ratios and repeatability, suggesting that the VAE-NT index is a robust and reliable tool for distinguishing VAE-NT from normal eyes. Further validation in broader populations and over longer follow-up periods is needed to support clinical translation.
Keywords: VAE-NT, Dynamic corneal response parameters, TOPSIS, Keratoconus, Corneal biomechanics
Received: 23 Mar 2025; Accepted: 20 Jun 2025.
Copyright: © 2025 Yang, Xu, Jiang, Zhu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jingyin Zhu, Huadong Hospital, Fudan University, Shanghai, China
Shihao Chen, Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
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