Smolek 1997.

Study characteristics
Patient Sampling	Retrospective, single‐centre, case‐control study. 300 TMS‐1 examinations (Tomey USA, Cambridge, MA) were collected from medical records at the LSU Eye Center
Patient characteristics and setting	Normal: < 1.5D cylinder, with‐the‐rule astigmatism >1.5 D cylinder, contact lens‐induced warpage, pellucid marginal degeneration, penetrating keratoplasty, radial keratectomy, and photorefractive keratectomy Keratoconus suspect: absence of any clinical signs, symptoms, or medical history that might point to the presence of keratoconus or any other condition in that eye, even though the videokeratographic appearance bore a striking resemblance to that of an eye with a minor conelike ectasia Keratoconus Exclusion criteria were unclear.
Index tests	The study reports the development of a pair of neural networks. One network detects and classifies clinical keratoconus and keratoconus suspects from among a variety of potentially confounding topographic patterns. A second network quantifies the severity of any conelike feature that matches the topographic pattern of clinical keratoconus or keratoconus suspect.
Target condition and reference standard(s)	Unclear who made the diagnosis. All cases were diagnosed before the analyses.
Flow and timing	It was unclear if the diagnoses were made by the same person(s). All participants were included in the analyses.
Comparative	Not applicable
Notes	Supported by National Eye Institute grants EY03311 and EY02377.
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient selection
Was a consecutive or random sample of patients enrolled?	No
Was a case‐control design avoided?	No
Did the study avoid inappropriate exclusions?	No
Could the selection of patients have introduced bias?		High risk
Are there concerns that the included patients and setting do not match the review question?			High
DOMAIN 2: Index test (All tests)
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Unclear
Was the model designed in an appropriate manner?	Yes
Could the conduct or interpretation of the index test have introduced bias?		Unclear risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Unclear
DOMAIN 3: Reference standard
Is the reference standard likely to correctly classify the target condition?	Unclear
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
Could the reference standard, its conduct, or its interpretation have introduced bias?		Unclear risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			Unclear
DOMAIN 4: Flow and timing
Did all patients receive the same reference standard?	Unclear
Were all patients included in the analysis?	Yes
Could the patient flow have introduced bias?		Unclear risk
DOMAIN 5: Comparative