Translating Ocular Biomechanics into Clinical Practice: Current State and Future Prospects

Abstract

Biomechanics – the study of the relationship between forces and function in living organisms – is thought to play a critical role in a significant number of ophthalmic disorders. This is not surprising, as the eye is a pressure vessel that requires a delicate balance of forces to maintain its homeostasis. Over the past few decades, basic science research in ophthalmology mostly confirmed that ocular biomechanics could explain in part the mechanisms involved in almost all major ophthalmic disorders such as optic nerve head neuropathies, angle closure, ametropia, presbyopia, cataract, corneal pathologies, retinal detachment, and macular degeneration. Translational biomechanics in ophthalmology, however, is still in its infancy. It is believed that its use could make significant advances in diagnosis and treatment. Several translational biomechanics strategies are already emerging, such as corneal stiffening for the treatment of keratoconus, and more are likely to follow. This review aims to cultivate the idea that biomechanics plays a major role in ophthalmology and that its clinical translation, lead by collaborative teams of clinicians and biomedical engineers, will benefit our patients. Specifically, recent advances and future prospects in corneal, iris, trabecular meshwork, crystalline lens, scleral and lamina cribrosa biomechanics are discussed.

Polarization microscopy for characterizing fiber orientation of ocular tissues

“…Several leading causes of visual impairment such as myopia [1], glaucoma [2], and keratoconus [3] are associated with abnormal ocular connective tissues [4]. Hence, to preserve vision, it is important to characterize two elements central to connective tissues, namely the orientation and organization of the collagen fibers that form them [5,6].…”

“…However, the accuracy, repeatability and robustness of the technique when applied to ocular tissues remains to be determined. Tendon and ligaments are generally similar to collagenous ocular tissues in terms of extracellular matrix composition [26], but there are differences in their structural hierarchies [9] and overall organization [4,[27][28][29]. Therefore, it cannot be taken for granted that PLM will apply to ocular tissues as it does to other tissues, and the performance of the technique must be assessed.…”

Optical coherence elastography – OCT at work in tissue biomechanics [Invited]

“…One such burgeoning non-OCE approach of great promise is Brillouin microscopy, as alluded to earlier [140,194,195]. OCE and Brillouin microscopy will continue to prove complementary, in the mechanical contrast they probe, the resolution and field of view they achieve, and the applications they are suited for.…”

The effect of strabismus muscle surgery on corneal biomechanics

“…e eye has been commonly thought of as an optical rather than a mechanical system; however, biomechanics can still play an important role in a number of different ophthalmic pathologies [1,2].…”