Biomechanical Diagnostics of the Cornea.

Biomechanics is the science concerned with the origin and effects of forces that act on living organisms. The cornea is a complex composite whose behavior depends on its structural subcomponents and their organizational motifs. A better understanding of its biomechanical features is essential to understand the consequences of procedures such excimer laser refractive surgery and corneal collagen crosslinking and to improve the detection and management of ectatic corneal diseases. Devices such as the Ocular Response Analyzer and the Corvis STL use an air-puff to perturb the cornea and assess biomechanical responses. Although both devices use similar approaches, data produced by them cannot be used interchangeably. Moreover, current commercial technologies lack capabilities for regional property discrimination, which is of paramount importance for comprehensive biomechanical analysis. To address this gap, other methodologies such as optical coherence elastography and Brillouin microscopy are being developed and early in vivo studies show promising results. Finally, another important tool for studying complex structures is computational modeling using the finite element method. The cornea can be represented as a mesh of smaller geometric elements with specific material properties. Advances in this area have the potential to enhance diagnosis, enable personalized risk assessment, and optimize treatment design toward the goal of improving safety and outcomes for corneal and refractive surgery patients.