Ocular Biomechanics In Health And Pathophysiology

Biomechanical mechanisms may contribute to a large number of visual processes and pathologies, including glaucoma, keratoconus, refractive surgery, accommodation, presbyopia, myopia, hyperopia, trauma, retinal detachment, ocular development, vitreous substitution, cataract surgery, corneal transplant, and many others. Departures from homeostatic loading may drive a large number of these processes in ways we are only beginning to recognize. This Research Topic will explore how ocular biomechanics contribute to both the homeostasis and pathophysiology of the eye and visual system. It is generally unknown whether changes in load drive changes in biomechanical properties or vice versa. Clarifying driving forces for disease and elucidating the pathophysiologic response will ultimately enable the development of targeted treatments for many ocular and visual diseases for which biomechanics plays a role.

Covering all major components of the ocular system, this state-of-the-art text is essential for vision scientists, biomedical engineers, and advanced clinicians with an interest in the role of mechanics in ocular function, disease, therapeutics, and surgery. With every chapter, leading experts strengthen the arguments that biomechanics is an indispensable and rapidly evolving tool for understanding and managing ocular disease.

This book focuses on the concept of ocular rigidity, the biomechanical properties and hydrodynamics of the human eye. The basics of anatomy and physiology are explored and the relevant data for the clinician are emphasized throughout the book. The engineering aspects as well as the clinical interpretation are presented to provide context. Ocular Rigidity, Biomechanics and Hydrodynamics of the Eye summarises recent evidence on ocular rigidity, but also provides a complete presentation of the data so far. The authors have recently worked on ocular rigidity corneal and globe biomechanics and hydrodynamics and the new, up-to-date data on the subject are highlighted in each chapter. The aim is to provide the framework or the understanding of these parameters and to determine their relevance in health and disease. This book will be an essential read for all practicing ophthalmologists looking to gain a more in-depth understanding of this interesting area of research particularly in refractive surgery and glaucoma.

While lecturing in recent months at a number of prominent institutions, I asked some of the residents and fellows whether and how they might benefit from a book on corneal biomechanics. The typical response was the look of a deer caught in the headlights as they tried to intuit the “appropriate” answer, but had little understanding or insight as to why this would be an important and useful knowledge base for them now, or in the future. I then posed the question differently. “Would a book that explained corneal biomechanical principles and testing devices and their application in detecting eyes at risk for developing keratoconus and post-LASIK ectasia, understanding the biomechanical impact of specific types of keratorefractive surgery and riboflavin UV-A corneal collagen cross-linking, and the impact of corneal biomechanics on the fidelity of intraocular pressure measurement and risk for glaucoma progression be of interest?” Framed in this context, the answer I got was a resounding, “Yes!” Therein lies a fundamental disconnect that highlights both the opportunity and need to educate all ophthalmologists about this nascent field. This comprehensive book is strengthened by the breadth of contributions from leading experts around the world and provides an important resource for ophthalmologists at all levels of training and experience. It gives a panoramic snapshot of our understanding of corneal biomechanics today, bridging the gap between theoretical principles, testing devices that are commercially available and in development as well as current and potential future clinical applications. While there has been a long-held appreciation that all types of keratorefractive surgery have an impact and interdependence on corneal biomechanics and wound healing, the initial finite element analyses that were applied to understand radial keratotomy were limited by incorrect assumptions that the cornea was a linear, elastic, homogenous, isotropic material.1 With the advent of excimer laser vision correction, critical observations indicated that Munnerlyn’s theoretic ablation profiles did not account for either lower or higher order (e.g. spherical aberration) refractive outcomes,2 suggesting that there were important components missing from the equation—e.g., corneal biomechanics and wound healing. In a seminal editorial, Roberts3 pointed out that the cornea is not a piece of plastic, but rather a material with viscoelastic qualities. Since that time, much has been learned about spatial and depth- related patterns of collagen orientation and interweaving, as well as the biomechanical response to different keratorefractive surgeries that sever tension-bearing lamellae, as the cornea responds to and redistributes stress induced by IOP, hydration, eye rubbing, blinking and extraocular muscle forces.3-6 The first reports of post-LASIK ectasia7 highlighted the need to identify a biomechanical signature of early keratoconus as well as corneas at high risk of developing ectasia irrespective of their current topography or tomography. The introduction of two instruments into clinical use—the Ocular Response Analyzer (ORA) and the Corneal Visualization Scheimpflug Technology (Corvis ST)—that allow measurement of various biomechanical metrics further catapulted the field. The availability of these instruments in routine clinical settings allowed the systematic study of the effect of age, collagen disorders, collagen cross-linking, corneal rings, flaps of various depths, contour, sidecut angulation, pockets, and flockets, just to name of few. Future application of biomechanics to the sclera may improve our understanding of the development and prevention of myopia, as well as scleral surgeries and treatments under development for presbyopia. It was appreciated by Goldmann and Schmidt that corneal thickness and curvature would influence the measurement of applanation tonometry. The recent ability to measure some corneal biomechanical metrics have led to IOP measurement that may be more immune both to their influence and the impact of central corneal thickness (CCT). Certain chapters in this book explain how a thin cornea could be stiffer than a thick one and that stiffness is also impacted by IOP, thereby precluding simplistic attempts to adjust IOP measurements using nomograms based upon CCT alone. Also highlighted is how corneal hysteresis, the ability of the cornea to absorb and dissipate energy during the bidirectional applanation response to a linear Gaussian air puff, appears to be an independent risk factor for glaucoma progression and rate of progression.9,10 This comprehensive book starts out with a section devoted to outlining basic biomechanical principles and theories, teaching us the language of what Dupps11 has referred to as “mechanospeak”, thus providing a context and common vocabulary to better comprehend the following chapters. By first defining basic concepts such as stress-strain relationships and creep, this theoretical basis is later applied to explain the pathogenesis of corneal diseases, e.g., explaining how a focal abnormality in corneal biomechanical properties precipitates a cycle of decompensation and localized thinning and steepening, clinically expressed as ectasia progression. These early chapters further detail biomechanical differences between in-vivo and ex-vivo testing, between human and animal corneas and sclera, and between methods of testing. The second section provides a thorough description of two FDA-approved devices to measure corneal biomechanics in the clinic (i.e., the ORA and the Corvis ST), as well as an overview of potential future technologies, including OCT with air puff stimulus, ocular pulse elastography, and Brilloiun microscopy. The third and final section of the book is a thorough treatise on how to interpret the metrics derived from the waveform provided by available clinical devices; their adjunct use in ectasia risk screening; the comparative biomechanical impact of various keratorefractive surgeries and corneal procedures such as PRK, LASIK, SMILE, and corneal collagen cross-linking; the impact of corneal biomechanics on IOP measurement; and potential biomechanical markers of enhanced susceptibility to glaucoma progression. This compendium of our current knowledge of corneal biomechanics, its measurement and application, provides a strong foundation to more fully understand advances in keratorefractive and corneal surgery, diseases, and treatments, all of which are interdependent on and influence inherent corneal biomechanical properties and behavior. Both the robust aspects and limitations of our current understanding are presented, including the challenge of creating accurate and predictive finite element models that incorporate the impact of IOP, corneal thickness, geometry, and scleral properties on corneal biomechanics. This book provides a key allowing clinical ophthalmologists and researchers to grasp the basics and nuances of this exciting field and to shape it as it evolves in the future.

Bridge the gap between ophthalmology and pathology with the 8th Edition of this comprehensive, easy-to-understand reference from Drs. Myron Yanoff and Joseph W. Sassani. Designed to keep you up to date with every aspect of the field, from current imaging techniques to genetics and molecular biology to clinical pearls, Ocular Pathology provides the concise yet complete information you need for board exams and clinical practice. Includes new coverage of genetics and molecular biology, complications in diabetes mellitus, and the role of new drugs and other treatments for macular degeneration. Covers the latest imaging techniques, including optical coherence tomography (OCT), anterior segment OCT (AS-OCT) and OCT-angiography. Contains new images throughout that provide updated correlations between pathological and clinical aspects of each disorder. Clinicopathological correlations are presented with side-by-side image comparisons to make clinical pearl boxes even more useful. Features more than 1,900 illustrations from the collections of internationally renowned leaders in ocular pathology. Presents information in a quick-reference outline format – ideal for today’s busy physician.

Ocular Disease—a newly introduced companion volume to the classic Adler’s Physiology of the Eye—correlates basic science and clinical management to describe the how and why of eye disease processes and the related best management protocols. Editors Leonard A. Levin and Daniel M. Albert—two of the world’s leading ophthalmic clinician-scientists—have recruited as contributors the most expert and experienced authorities available in each of the major areas of ophthalmic disease specific to ophthalmology: retina, cornea, cataract, glaucoma, uveitis, and more. The concise chapter structure features liberal use of color—with 330 full-color line artworks, call-out boxes, summaries, and schematics for easy navigation and understanding. This comprehensive resource provides you with a better and more practical understanding of the science behind eye disease and its relation to treatment. Covers all areas of disease in ophthalmology including retina, cornea, cataract, glaucoma, and uveitis for the comprehensive information you need for managing clinical cases. Presents a unique and pragmatic blend of necessary basic science and clinical application to serve as a clinical guide to understanding the cause and rational management of ocular disease. Features 330 full-color line artworks that translate difficult concepts and discussions into concise schematics for improved understanding and comprehension. Provides the expert advice of internationally recognized editors with over 40 years of experience together with a group of world class contributors in basic science and clinical ophthalmology.