Ocular biomechanics of the anterior segment

Abstract

The thesis investigates methods of examining corneal biomechanics using non-contact tonometry and introduces novel techniques to investigate corneal material properties in vivo. A comprehensive systems analysis of the CorvisST (CST) and Ocular Response Analyser (ORA) was performed. Pressure sensors were used to characterisation the airflow produced by the CST and the ORA. Distinct differences were observed between the central airflow pressures between the two devices: the CST pressure was higher and of shorter duration. Scheimpflug high-speed imaging via the CST allowed components of the corneal deformation to be investigated and the development of a 3D deformation matrix (time, depth and spatial resolution) through tracing of the anterior and posterior corneal surface. Measures of whole eye movement (WEM) with CST were found to be robust. WEM demonstrated an asymmetric profile and a correction method was developed to address the corneal deformation matrix for this asymmetry. Novel methods for characterisation of intrinsic material characteristics of the cornea were developed using numerical and graphical analytical procedures. Application of these parameters was tested on enucleated porcine eyes across a wide range of manometry internal ocular pressure (MIOP). The dynamic E-Modulus was found to be most affected by MIOP change. To investigate the in vivo distribution and heterogeneity of the corneal biomechanics, a novel set-up allowed the mapping of corneal biomechanics across the cornea using the CST (central, paracentral, peripheral) and ORA (central, peripheral). Biometric and demographic grouping of subjects allowed detection of discriminating factors between individuals. The results suggest that the in vivo cornea of healthy human adults can be characterised as a viscoelastic, damped system for longitudinal strain and a highly oscillating system for lateral strain. The cornea is approximately homogenous for measures of rigidity and dynamic E-Modulus but other corneal material characteristics (longitudinal and lateral strain, hysteresis, damping and compressibility) demonstrated regional differences. The experimental design employed allowed for strict control of biometric and biomechanical intersubject variables, based on gold-standard techniques as well as newly-developed methods, thereby creating a normative database for future use.