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

Abstract

Biomechanics is the study of the relationship between forces and function in living organisms and 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 the 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.

• Brillouin microscopy
• intraocular pressure
• ocular biomechanics
• optical coherence tomography
• ophthalmic pathologies
• personalised medicine
• translational biomechanics

DECLARATION OF INTEREST

MJAG acknowledges support from the Singapore Ministry of Education, Academic Research Fund, Tier 1 and from a NUS Young Investigator Award (NUSYIA_FY13_P03). Acknowledgment is also made to the donors of the NGR, a program of the Bright Focus Foundation (formerly American Health Assistance Foundation or AHAF). NGS acknowledges a proportion of his financial support from the Department of Health through the award made by the UK National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Biomedical Research Centre for Ophthalmology. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. IAS acknowledges support from the National Institutes of Health grants R01-EY023966 and P30-EY008098. SHY and GS acknowledge support (in part) by NIH P41-EB015903, R21EY023043, K25EB015885, and the Harvard Clinical and Translational Science Center (NIH UL1-RR025758). WJD acknowledges support in part by NIH R01 EY023381, the National Keratoconus Foundation/Discovery Eye Foundation, Unrestricted and Challenge Grants from Research to Prevent Blindness to the Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. WJD is a recipient of a Research to Prevent Blindness Career Development Award. SHY and GS are listed as inventors on intellectual property held by Massachusetts General Hospital related to biomechanical measurement. WJD is listed as an inventor on intellectual property held by Cleveland Clinic related to biomechanical measurement and modeling and has received research funding and royalties related to use of IP from Avedro, Zeiss and Topcon. WJD is a consultant to Ziemer.