Corneal Viscous Properties Cannot Be Determined From Air-Puff Applanation.

Abstract

To assess whether corneal viscous properties are measureable with air-puff applanation in patients. The study had 312 normal eyes, 107 fellow eyes of patients with keratoconus, and 289 keratoconic eyes. The Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) deformation data for all eyes were analyzed using two models. First, a standard linear solid model (SLM) assumed the cornea was an elastic material only. Second, a two-compartment Kelvin-Voigt model (KVM) assumed the cornea was a visco-elastic material. Corneal stiffness and viscosity were calculated. Further, the deflection amplitude was phase shifted virtually relative to the air-puff applanation force to assess whether the KVM was capable of detecting corneal viscous properties from air-puff applanation. This was similar in concept to measured viscoelastic deformations in other soft tissues. The hysteresis area was also calculated with deformation (cornea and whole globe) and deflection (cornea only) amplitude. The greater the magnitude of the hysteresis area, the greater was the magnitude of corneal viscosity (µc). Both the SLM and KVM reported similar magnitudes of corneal stiffnesses (correlation coefficient > 0.99). However, for a given model, corneal stiffness was significantly different between normal, fellow, and keratoconic eyes (P = .001). From the KVM, the corneal viscosity was different between groups (P = .001) but was small in magnitude (order of 10-9). The deflection hysteresis area was also small in magnitude (order of 10-6). In contrast, the KVM detected significant corneal viscosity only when the deflection amplitude was virtually phase shifted with respect to the air-puff applanation force. No significant corneal viscous response was detected in patients who had air-puff applanation. [J Refract Surg. 2019;35(11):730-736.].