This video discusses the use of corneal epithelial thickness and epithelial thickness topographic variability as a potentially novel epithelial clinical indicator for biomechanical corneal instability in keratoconus. These clinical parameters can be used with other topographic and Scheimpflug tomographic screening indicators such as irregular corneal thickness and anterior surface topographic variability. The ease of use and the reliable and predictable measurements suggest that epithelial imaging by AS-OCT holds promise for wider clinical application, such as screening of young adults for early keratoconus, and in a much wider perspective, potential candidates for laser cornea refractive surgery.