Michael W Belin

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Journals/Publications

• Koh, S., Ambrósio, R., Inoue, R., Belin, M. W., Maeda, N., & Nishida, K. (2025). Predictive value of enhanced corneal biomechanical parameters for ectasia progression. Japanese journal of ophthalmology.
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  To determine whether corneal biomechanical parameters can predict ectasia progression.
• Lopes, B. T., Belin, M. W., Henriquez, M. A., Izquierdo, L., Kohnen, T., & Ambrosio, R. (2024). Enhancing corneal ectasia susceptibility detection: analysis of a new algorithm (BAD-D v4). Scientific reports, 14(1), 30226.
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  Accurate detection of post-refractive ectasia susceptibility is essential during preoperative evaluation for laser vision correction (LVC) due to the risk of progressive corneal ectasia and vision decline post-surgery. Despite improved screening and a reduced incidence from 0.66 to 0.033%, iatrogenic ectasia remains a concern due to the severe vision loss it can cause, highlighting the need for more accurate detection tools. A new optimized version of the Belin/Ambrósio Enhanced Ectasia Display version 4 (BAD-D v4) was developed and validated across 26 international centers to enhance the detection of keratoconus and very asymmetric ectasia and to assess the risk of post-refractive ectasia. Analyzing a dataset of 3,886 eyes from 3,351 patients, including normal, keratoconus (KC), and cases with very asymmetric ectasia (VAE) categories, having one eye with normal topography (VAE-NT and the fellow eye with clinical ectasia (VAE-E). The study utilized an optimized logistic regression algorithm improving diagnostic accuracy. The BAD-D v4 showed superior efficacy in differentiating normal eyes from ectatic conditions, with Area Under the Receiver Operating Characteristic Curve (AUROC) scores of 0.997 and 0.998 in training and testing samples for normal versus clinical ectasia. Additionally, in Normal vs. Disease (KC + VAE), the AUROC was 0.974 and 0.966, and in the challenging Normal vs. VAE-NT diverse group, it scored 0.905 and 0.858. These results outperformed the current version (BAD-D v3) and were comparable to the Pentacam Random Forest Index in all tested scenarios, highlighting the potential of BAD-D v4 in early ectasia detection, without altering the index scale or the end-user experience.
• Sedaghat, M. R., Ostadi-Moghaddam, H., Momeni-Moghaddam, H., Motaei, S., Roberts, C. J., Belin, M. W., & Oladi Abbas Abadi, S. (2024). Comparison of corneal biomechanical parameters in healthy corneas with symmetric and asymmetric bow-tie topographic pattern with inferior and superior steepening. International ophthalmology, 44(1), 22.
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  To compare the corneal biomechanical parameters in healthy corneas with symmetric and asymmetric bow-tie topographic patterns.
• Sedaghat, M. R., Sadeghi, J., Varshovi-Jaghargh, I., Heravian, J., Belin, M. W., & Momeni-Moghaddam, H. (2024). Effect of Astigmatism Treatment With Three Excimer Lasers After Photorefractive Keratectomy. Eye & contact lens, 50(9), 401-405.
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  To compare astigmatism correction after photorefractive keratectomy (PRK) using three excimer laser devices, Alcon Wavelight EX500, Schwind Amaris 1,050, and Technolas Teneo317 M2.
• Szalai, E., Belin, M. W., Szijártó, Z., & Csutak, A. (2024). Visual Recovery and Endothelial Repopulation after DMEK Graft Removal and Vitrectomy for Late Endophthalmitis: A Case Report. Case reports in ophthalmology, 15(1), 736-741.
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  The aim of the study was to report a unique case with excellent clinical outcomes after late endophthalmitis following Descemet's membrane endothelial keratoplasty (DMEK) surgery requiring donor graft removal without replacement.
• Epstein, R., Belin, M., Gravemann, D., Littner, R., & Rubinfeld, R. (2023). EpiSmart Crosslinking for Keratoconus: A Phase 2 Study. Cornea, 42(7), 858-866. doi:10.1097/ICO.0000000000003136
• Miura, M., Leon, P., Nahum, Y., Böhm, M. S., Mimouni, M., Belin, M. W., Johns, L., & Ciolino, J. B. (2023). Recurrent Keratoconus: Corneal Transplants for Keratoconus Develop Tomographic Ectatic Changes. Cornea, 42(6), 708-713.
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  The purpose of this study was to evaluate postoperative Scheimpflug imaging changes during the first 5 years after penetrating keratoplasty (PK) in patients with keratoconus (KC).
• Ambrósio, R., Machado, A. P., Leão, E., Lyra, J. M., Salomão, M. Q., Esporcatte, L. G., Filho, J. B., Ferreira-Meneses, E., Sena, N. B., Haddad, J. S., Neto, A. C., Castelo de Almeida, G., Roberts, C. J., Elsheikh, A., Vinciguerra, R., Vinciguerra, P., Bühren, J., Kohnen, T., Kezirian, G. M., , Hafezi, F., et al. (2022). Optimized artificial intelligence for enhanced ectasia detection using Scheimpflug-based corneal tomography and biomechanical data. American journal of ophthalmology.
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  To optimize artificial intelligence (AI) algorithms to integrate Scheimpflug-based corneal tomography and biomechanics to enhance ectasia detection.
• Belin, M. W., Jang, H. S., & Borgstrom, M. (2022). Keratoconus: Diagnosis and Staging. Cornea, 41(1), 1-11.
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  The advent of refractive surgery and corneal cross-linking for ectatic disease has further highlighted the need to recognize early or subclinical ectatic disease. Historical systems depend on anterior corneal changes that occur late in the disease course and are commonly associated with visual loss. Tomographic imaging allows for the acquisition of posterior corneal surface data and corneal thickness distribution. This led to the development of modalities to diagnose early or subclinical keratoconus and to screen patients for refractive surgery.This article reviews the modern methods for assessing changes in posterior corneal surface and pachymetric distribution, now accepted by the major cornea societies to be the hallmarks of ectatic disease. Screening tools utilized by the commonly used tomographic imaging devices are discussed, and the difference between screening for ectasia and diagnosing keratoconus is highlighted. The Belin ABCD staging and classification system and the ABCD Progression Display are reviewed as a new grading and monitoring system that can be used for earlier intervention and prevention of visual loss in keratoconus.
• Belin, M., & Jang, H. S. (2022). Confidence intervals for assessing ectatic changes post-crosslinking using the ABCD grading system. Clinical & Experimental Ophthalmology, 49, 888-889.
• Epstein, R. J., Belin, M. W., Gravemann, D., Littner, R., & Rubinfeld, R. S. (2022). EpiSmart® Crosslinking for Keratoconus: A Phase 2 Study. Cornea.
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  The aim of this study was to assess changes in visual acuity after epithelium-on ("epi-on") corneal crosslinking after a diagnosis of keratoconus.
• Flockerzi, E., Vinciguerra, R., Belin, M. W., Vinciguerra, P., Ambrósio, R., & Seitz, B. (2022). Correlation of the Corvis Biomechanical Factor with tomographic parameters in keratoconus. Journal of cataract and refractive surgery, 48(2), 215-221.
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  To investigate the relationship between corneal biomechanics and keratoconus (KC) severity as described by tomographic parameters.
• Sedaghat, M. R., Momeni-Moghaddam, H., Belin, M. W., Savardashtaki, M., Naroo, S. A., & Robabi, H. (2022). Acute Hydrops with Total Corneal Edema in a Very Young Child with Keratoconus: The Youngest Age Reported Case. Case reports in ophthalmological medicine, 2022, 2381703.
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  To present the youngest age ever reported for acute corneal hydrops with total corneal edema in a child with advanced bilateral keratoconus.
• Vaidya, N. S., Daneshmand, A., Epstein, R. J., Majmudar, P. A., Belin, M. W., Parsons, E. C., & Rubinfeld, R. S. (2022). Pachymetric Assessment After EpiSmart Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia. Clinical ophthalmology (Auckland, N.Z.), 16, 1829-1835.
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  To assess the change in corneal pachymetry after a novel epithelium-on (EpiSmart) corneal crosslinking procedure (CXL).
• Xanthopoulou, K., Seitz, B., Belin, M. W., & Flockerzi, E. (2022). Reliability analysis of successive Corvis ST® measurements in keratoconus 2 years after accelerated corneal crosslinking compared to untreated keratoconus corneas. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie.
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  To assess the reliability of successive Corvis ST® measurements (CST, Oculus, Wetzlar, Germany) in keratoconus (KC) ≥ 2 years after accelerated corneal crosslinking (9 mW/cm, 10 min, 5.4 J/cm) compared to untreated KC corneas.
• Danesh, Z., Sedaghat, M. R., Momeni-Moghaddam, H., Yekta, A. A., & Belin, M. W. (2021). Corneal Stability and Visual Acuity 1 Year After Corneal Cross-linking Assessed Using the ABCD Keratoconus Staging System. Journal of refractive surgery (Thorofare, N.J. : 1995), 37(10), 700-706.
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  To assess corneal stability and corrected distance visual acuity (CDVA) 3, 6, and 12 months following corneal cross-linking (CXL) using the ABCD keratoconus staging system.
• Flockerzi, E., Vinciguerra, R., Belin, M. W., Vinciguerra, P., Ambrósio, R., & Seitz, B. (2021). Combined biomechanical and tomographic keratoconus staging: Adding a biomechanical parameter to the ABCD keratoconus staging system. Acta ophthalmologica.
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  This retrospective cross-sectional study evaluated the potential of an additional biomechanical parameter 'E' as an addition to the tomographic ABCD ectasia/keratoconus (KC) staging.
• Padmanabhan, P., Belin, M. W., Padmanaban, V., & Sudhir, R. R. (2021). Extreme corneal flattening following collagen crosslinking for progressive keratoconus. European journal of ophthalmology, 31(4), 1546-1552.
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  To study the clinical, tomographic and densitometric features of eyes that showed >5 D of corneal flattening following collagen crosslinking (CXL) for progressive keratoconus and to identify preoperative predictive factors for such a response.
• Padmanabhan, P., Belin, M. W., Sudhir, R. R., Mukundan, D., Chidambaram, H., & Ambrósio, R. (2021). Implications of Diagnostic Drops on Scheimpflug Tomography: The Proper Order for Clinical Testing. Cornea.
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  The purpose of this article was to study the impact of instillation of 1% fluorescein and mydriatics on measurements made by Scheimpflug imaging.
• Sedaghat, M. R., Momeni-Moghaddam, H., Azimi Khorasani, A., Belin, M. W., Monfared, N., Wolffsohn, J. S., Pakdel, M., Farrokh Ghate, M., & Hemmatian, Z. (2021). Comparison of Keratoconus Cone Location of Different Topo/tomographical Parameters. Current eye research, 46(11), 1666-1672.
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  : To compare the corneal cone location on different maps and instruments, and their agreements, with elevation maps.: In 90 left eyes with bilateral keratoconus, the apex of cone location was determined based on the maximum simulated keratometry (Kmax) location on the anterior sagittal curvature map by Pentacam HR, the maximum curvature on the mean curvature map by ATLAS 9000, most elevated point of the island of positive elevation relative to the best fit sphere on the front and back corneal elevation maps by Pentacam HR, and thinnest point on the thickness map by Pentacam HR and Orbscan, and the thinnest points on pachymetry and epithelial thickness maps by RTVue OCT.: There was a significant difference among the location on different maps along the - and -axes (
• Sedaghat, M. R., Momeni-Moghaddam, H., Belin, M. W., Piñero, D. P., Akbarzadeh, R., Ambrósio, R., & Hosseini, S. R. (2021). Comparative analysis of two different types of intracorneal implants in keratoconus: A corneal tomographic study. European journal of ophthalmology, 31(4), 1517-1524.
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  To evaluate changes in visual acuity and corneal tomographic outcomes at 6 months after femtosecond-laser assisted implantation of two different types of intracorneal implants in keratoconus.
• Sinjab, M. M., Rubinfeld, R. S., Wagner, K., Parsons Jnr, E. C., Cummings, A. B., & Belin, M. W. (2021). Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease. Clinical ophthalmology (Auckland, N.Z.), 15, 1317-1329.
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  To assess the effectiveness of a novel treatment for patients with advanced corneal ectasia and loss of visual acuity (VA). Conductive keratoplasty (CK) is performed to improve VA followed by epithelium-on (epi-on) corneal crosslinking (CXL) to stabilize the cornea after CK.
• Vinciguerra, R., Belin, M. W., Borgia, A., Piscopo, R., Montericcio, A., Confalonieri, F., Legrottaglie, E. F., Rosetta, P., & Vinciguerra, P. (2021). Evaluating keratoconus progression prior to crosslinking: maximum keratometry vs the ABCD grading system. Journal of cataract and refractive surgery, 47(1), 33-39.
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  To evaluate the correlation between changes in maximum keratometry (Kmax) and ABC values from the ABCD Progression Display (Pentacam) in progressive keratoconus (KC) and to evaluate whether the ABC changes were able to detect progression earlier than Kmax.

Presentations

• Belin, M. (2023, April 22-23). 1. Analysis of Peer Reviewed Keratoconus Methods
  2. Determining Keratoconus Staging, Progression & Prognosis. IKA Keratoconus Symposium. Scottsdale, AZ: International Keratoconus Academy of Eye Care Professionals.
• Belin, M. (2023, June 15-17). Comprehensive Course on Cornea Tomography. SOE Biannual Meeting. Prague, Czech Republic: European Society of Ophthalmology Congress.
• Belin, M. (2023, June 29-July 1). 1. Clinical Applications of the Belin ABCD Progression Display
  2. Anterior Segment Tomography
  3. Epi-On CXL - EpiSmart Phase 3 Trial. 21st Annual SICSSO Meeting. Catania, Italy: International Congress of the Italian Society of Stem Cells and Ocular Surface (SICSSO).
• Belin, M. (2023, May 26-28). Ectasia Progression: Diagnosis, Prognosis & Risk Factors. EuCornea Annual Meeting. Barcelona, Spain: European Society of Cornea & Ocular Surface Disease Specialists.
• Belin, M. (2023, May 5-6). 1. Comprehensive Course Corneal Tomography
  2. Peer Reviewed or Poorly Reviewed
  3. Determining Ectasia Progression. New Zealand Branch, RANZCO Meeting. Wellington, New Zealand: The Royal Australian and New Zealand Collge of Ophthalmologists (RANZCO).
• Belin, M. (2023, November 3-6). Analysis of Corneal Shape (AAO Course). AAO Annual Meeting 2023. San Francisco, CA: American Academy of Ophthalmology (AAO).

Poster Presentations

• Belin, M. (2023, November 26-28). The Biomechanical E-Staging - In Vivo Assessment of Corneal Biomechanics in Keratoconus. EVER Congress 2023. Valencia, Spain: European Association for Vision and Eye Research.