Background: Keratoconus is a prevalent ectatic disorder marked by progressive bilateral corneal thinning, resulting in a conical corneal shape. This non-inflammatory thinning primarily occurs in the infero-temporal region, serving as a key diagnostic feature for keratoconus. This study aimed to compare the efficacy of Anterior Segment Optical Coherence Tomography (AS-OCT) in detection of subclinical keratoconus with the efficacy of the Pentacam. Methods: This was a comparative cross-sectional study designed to compare the efficacy of AS-OCT in detection of subclinical keratoconus with the efficacy of the Pentacam. The study included 30 eyes of patients aged between 18-40 years old from both sexes, presenting with astigmatism more than -2.00 Diopters. The methodology involved a Corneal thickness measurements were obtained using AS-OCT and Pentacam Scheimpflug imaging. Data collection adhered to specific inclusion and exclusion criteria. Results: Association between pentacam diagnosis and other studied parameters showed a significantly higher measurement of autorefraction cylinder, K1 and K2 readings keratoconus cases compared to free and suspect groups.