Quantitative Evaluation of In Vivo Corneal Biomechanical Properties after SMILE and FLEx Surgery by Acoustic Radiation Force Optical Coherence Elastography

Chirp excitation for natural frequency optical coherence elastography

Optical coherence elastography (OCE) has recently been used to characterize the natural frequencies of delicate tissues (e.g., the in vivo human cornea) with sub-micron tissue oscillation magnitudes. Here, we investigate broadband spectrum sample stimulation using a contact-based piezoelectric transducer (PZT) chirp excitation and compare its performance with a non-contact, air-pulse excitation for OCE measurements on 1.0-7.5% agar phantoms and an ex vivo porcine cornea under intraocular pressures (IOPs) of 5-40 mmHg. The 3-ms duration air-pulse generated a ∼0-840 Hz excitation spectrum, effectively quantifying the first-order natural frequencies in softer samples (e.g., 1.0%-4.0% agar: 239-782 Hz, 198 Hz/%; porcine cornea: 68-414 Hz, 18 Hz/mmHg, IOP: 5-25 mmHg), but displayed limitations in measuring natural frequencies for stiffer samples (e.g., 4.5%-7.5% agar, porcine cornea: IOP ≥ 30 mmHg) or higher order natural frequency components. In contrast, the chirp excitation produced a much wider spectrum (e.g., 0-5000 Hz), enabling the quantification of both first-order natural frequencies (1.0%-7.5% agar: 253-1429 Hz, 181 Hz/%; porcine cornea: 76-1240 Hz, 32 Hz/mmHg, IOP: 5-40 mmHg) and higher order natural frequencies. A modified Bland-Altman analysis (mean versus relative difference in natural frequency) showed a bias of 20.4%, attributed to the additional mass and frequency introduced by the contact nature of the PZT probe. These findings, especially the advantages and limitations of both excitation methods, can be utilized to validate the potential application of natural frequency OCE, paving the way for the ongoing development of biomechanical characterization methods utilizing sub-micron tissue oscillation features.

Optical coherence elastography measures the biomechanical properties of the ex vivo porcine cornea after LASIK

Significance

The biomechanical impact of refractive surgery has long been an area of investigation. Changes to the cornea structure cause alterations to its mechanical integrity, but few studies have examined its specific mechanical impact.

Aim

To quantify how the biomechanical properties of the cornea are altered by laser assisted in situ keratomileusis (LASIK) using optical coherence elastography (OCE) in ex vivo porcine corneas.

Approach

Three OCE techniques, wave-based air-coupled ultrasound (ACUS) OCE, heartbeat (Hb) OCE, and compression OCE were used to measure the mechanical properties of paired porcine corneas, where one eye of the pair was left untreated, and the fellow eye underwent LASIK. Changes in stiffness as a function of intraocular pressure (IOP) before and after LASIK were measured using each technique.

Results

ACUS-OCE showed that corneal stiffness changed as a function of IOP for both the untreated and the treated groups. The elastic wave speed after LASIK was lower than before LASIK. Hb-OCE and compression OCE showed regional changes in corneal strain after LASIK, where the absolute strain difference between the cornea anterior and posterior increased after LASIK.

Conclusions

The results of this study suggest that LASIK may soften the cornea and that these changes are largely localized to the region where the surgery was performed.

In vivo corneal elastography: A topical review of challenges and opportunities

Clinical measurement of corneal biomechanics can aid in the early diagnosis, progression tracking, and treatment evaluation of ocular diseases. Over the past two decades, interdisciplinary collaborations between investigators in optical engineering, analytical biomechanical modeling, and clinical research has expanded our knowledge of corneal biomechanics. These advances have led to innovations in testing methods (ex vivo, and recently, in vivo) across multiple spatial and strain scales. However, in vivo measurement of corneal biomechanics remains a long-standing challenge and is currently an active area of research. Here, we review the existing and emerging approaches for in vivo corneal biomechanics evaluation, which include corneal applanation methods, such as ocular response analyzer (ORA) and corneal visualization Scheimpflug technology (Corvis ST), Brillouin microscopy, and elastography methods, and the emerging field of optical coherence elastography (OCE). We describe the fundamental concepts, analytical methods, and current clinical status for each of these methods. Finally, we discuss open questions for the current state of in vivo biomechanics assessment techniques and requirements for wider use that will further broaden our understanding of corneal biomechanics for the detection and management of ocular diseases, and improve the safety and efficacy of future clinical practice.