Pediatric Corneal Epithelial Thickness Profiles by Anterior Segment Optical Coherence Tomography: Normative Data and Clinical Implications

Purpose To determine normative corneal epithelial thickness (CET) profiles in healthy Turkish children using anterior segment optical coherence tomography (AS-OCT), and to explore regional variations and associations with demographic and refractive parameters. Methods This cross-sectional observational study was conducted at a tertiary eye hospital and included 86 healthy children aged 7 to 18 years. One eye per participant was randomly selected. All participants underwent complete ophthalmic examination, cycloplegic autore-fraction, and AS-OCT imaging. CET measurements were obtained from central (2-mm), paracentral (5-mm), and midperipheral (6-mm) zones across eight radial sectors. Statistical analyses included sex-based comparisons, quadrant-based thickness differences, and correlation analyses with age and refractive parameters. Results Mean central CET was 53.7 ± 4.6 µm. Epithelial thickness (ET) decreased toward the periphery, with inferior and inferonasal sectors being thickest and superior sectors thinnest. Males exhibited significantly greater CET in several paracentral and midperipheral sectors ( P < .05). Quadrant-based comparisons revealed consistent asymmetry: ET was greater in inferior and nasal sectors compared to superior and temporal regions, whereas corneal thickness was lower in the inferior and temporal quadrants relative to superior and nasal counterparts ( P < .001). Central CET showed no correlation with age or refractive error, whereas paracentral nasal and temporal sectors exhibited weak age-related thinning ( P < .05). Conclusions This study provides normative pediatric CET data, highlighting characteristic spatial variations and subtle sex-based differences. These findings support the clinical utility of epithelial mapping in early keratoconus detection and its integration into artificial intelligence–based diagnostic systems.