One of the most promising recent advancements in anterior segment diagnostics is the ability to visualize and quantify the thickness of individual corneal layers. With the latest Pentacam® Cornea OCT software extension, clinicians now have access to several multi-layer thickness maps, covering tear film, epithelium, Bowman's layer, and stroma, from a single scan taken in just one second. This level of structural differentiation has not previously been achieved in routine clinical practice.
A Technological Breakthrough
Leveraging its ultra-high axial resolution of 1.9 µm over the entire cornea, the OCT module can now differentiate even the finest anatomical boundaries, converting raw B-scans into segmented layer maps. Subsequent updates will enable mapping of Descemet’s membrane and endothelium, further enriching diagnostic depth.
Why It Matters: Evidence-Based Benefits
Epithelial Thickness Mapping
Epithelial thickness has long been studied as an early biomarker for ectatic changes. Subtle patterns such as the characteristic "doughnut shape" seen in subclinical keratoconus are often detectable even when topographic readings appear normal. In one study, epithelial mapping altered clinical decisions in 16% of preoperative cases, underscoring its value in refractive screening and risk stratification.5
Bowman's Layer Thickness
Bowman’s layer is emerging as an at least equally important structural indicator. Recent studies have shown that Bowman’s thickening may precede epithelial thinning in the fellow eyes of unilateral keratoconus patients.6
Figure 5: Pentacam Cornea OCT scan with automatically detected layer boundaries
Stromal Thickness Mapping
Stromal thickness profiles support procedural planning and post-surgical evaluation by offering detailed maps of tissue distribution. Data from advanced SD-OCT devices show that stromal thickness follows a centrifugal gradient – thin in the center and thicker peripherally – a pattern that provides valuable foundation for ablation planning and optimizing surgical outcomes.7
Tear Film Differentiation
Although only a snapshot in time, tear film thickness can affect epithelial measurements. Isolating this layer adds clarity in cases where irregularity could otherwise be attributed to underlying pathology. It is a clinically meaningful addition to accurate epithelial interpretation.
Added Clinical Value
Early Detection & Risk Stratification:
Combining epithelial and Bowman's layer maps allows for a more sensitive evaluation of early-stage ectasia, especially in borderline topographies.
Diagnostic Confidence:
Layer-by-layer analysis enhances the ability to distinguish epithelial masking effects from true stromal thinning.
Figure 6: Two consecutive scans of the same patient showing the thickness map of the tear film (middle) and the epithelium (right). On the left side is the combination of both layers, showing that a clear separation of tear film and epithelium avoids misinterpretation of irregularities as epithelial changes.
Surgical Planning:
For refractive surgery, separate tear film, epithelial and stromal thickness maps allow for customized ablation strategies, improved centering, and better prediction of healing response.
Efficiency and Usability:
Layer segmentation is performed automatically and fully integrated into the standard workflow. This not only enables users to quickly spot abnormalities, but also provides a detailed and structured dataset for interpretation.
A New Structural Perspective
The ability to isolate and quantify each corneal layer is a long-awaited advancement in anterior segment imaging. In particular, the ability to map Bowman's layer represents a diagnostic breakthrough with broad implications for early detection and clinical confidence. Layer-based diagnostics bring OCT closer to the standard of histological interpretation, bridging the gap between structural imaging and personalized treatment.
The Pentacam® Cornea OCT continues to lead the way – not just through high-resolution imaging, but by delivering actionable clinical insight through intelligent, layer-specific analysis.
The views and opinions expressed here may not necessarily reflect those of Bryn Mawr Communications or Cataract & Refractive Surgery Today Global.
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2. Villavicencio OF et al. Independent Population Validation of the Belin/Ambrósio Enhanced Ectasia Display: Implications for Keratoconus Studies and Screening. Int J Kerat Ect Cor Dis. 2014;3(1):1–8. doi:10.5005/jp-journals-10025-1069
3. Correia et al. Topometric and Tomographic Indices for the Diagnosis of Keratoconus. Int J Kerat Ect Cor Dis. 2012;1(2):92-99. doi:10.5005/jp-journals-10025-1018
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6. Pircher N, Kilian R, Beer F, et al. Diagnostic performance of corneal epithelium- and Bowman's layer thickness mapping in patients with unilateral Keratoconus. Graefes Arch Clin Exp Ophthalmol. 2025;263(5):1383-1389. doi:10.1007/s00417-025-06750-8
7. Abusamak M, Issa SM, Alomari AF, et al. Corneal stromal mapping characteristics in normal corneas using anterior segment SD-OCT. Front Med (Lausanne). 2024;11:1485718. Published 2024 Dec 2. doi:10.3389/fmed.2024.1485718
8. Reisdorf S, Fayaz S; AI-Powered Assistant for Detecting Corneal Pathology in Optical Coherence Tomography Images. Invest. Ophthalmol. Vis. Sci. 2025;66(8):5413.
9. Tey KY, Cheong EZK, Ang M. Potential applications of artificial intelligence in image analysis in cornea diseases: a review. Eye Vis (Lond). 2024;11(1):10. Published 2024 Mar 7. doi:10.1186/s40662-024-00376-3
