AbstractThe corneal thickness as an object for studies was recognized in the renaissance. A value of 1 mm, representing the maximally swollen human cornea, was reported. Optical in vivo measurements were done by Blix in 1880 reporting a thickness of about 0.5 mm, the value that we today know is correct.Blix lived in “the golden age of physiologic optics”. His interest was the contribution of the cornea to the optical refraction of the eye, and was thus the distance between the anterior and the posterior surface rather than the thickness of the cornea as such.A biomechanical interest in corneal thickness was initiated by the studies of tonometry, in particular Hans Goldmann’s development of applanation tonometry. He predicted correctly that corneal thickness would influence the estimated pressure reading.Another physiological aspect of the cornea is its transparency. Earlier explanations by equal refractive index was revolutionized by the interference theory by David Maurice. Optical transparency required a regular fiber pattern, and thus a stabilized thickness and stromal hydration. This led to extensive interest in the permeability of the limiting layers, in particular the transport of fluid across the endothelium. The physiological concepts required a regulated or stabilized thickness. The thickness as such became interesting.The human cornea is thinner in the center than more peripherally and the central, presumably regulated central thickness (CCT) became a biometric and clinical study object. The exact individual value became of interest. Several optical and later ultrasonic principles were presented.Questions addressed were: Is CCT a life‐long, age independent characteristics. Is CCT diagnostic for certain disease conditions (e.g. Macular dystrophy of Groenouw). Is CCT a useful clinical parameter to follow disease processes (e.g. progression in keratoconus or acute changes in graft rejections).Today refractive surgery has revived the interest in biomechanical and optical properties of the cornea. Modern computer technology allows for a description of the “thickness profile” of the entire cornea. This gives us access to an overwhelming amount of data, and reopen many issues of the past. We must realize, however, that what we see is the pendulum swinging back to the problems of the last century. The machinery is smarter but many of the basic questions remain to be solved.
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