This video evaluates Scheimpflug measurements in distinguishing highly asymmetric keratoconus from normal corneas by using a comparative analysis of Pentacam HR analysis of the forme fruste eye with normal controls. A study revealed that highly asymmetric keratoconus eyes are thinner than normal corneas, but otherwise difficult to distinguish using Scheimpflug imaging. The combined ARTMax and BAD-D metric failed to identify 40% of forme fruste eyes.