In situ assessment of lens elasticity with noncontact optical coherence elastography

Anterior segment applications of optical coherence elastography in ophthalmic and vision science: a systematic review of intrinsic measurement techniques and clinical relevance

Optical coherence elastography (OCE) is a non-invasive imaging technique that measures the biomechanical properties of materials and tissues. This systematic review focuses on the applications of OCE in the anterior segment of the eye, including the cornea, iris, and crystalline lens, and its clinical relevance in diagnosing and managing ocular diseases. A systematic literature review was conducted using the PRISMA framework to identify studies published between 2014 and 2024. The review included studies that reported intrinsic biomechanical properties of anterior segment tissues measured using OCE. Databases searched included Scopus, Pub Med, and IEEE Xplore. Twenty-five studies met the inclusion criteria. The review found that OCE has been used to measure intrinsic biomechanical parameters such as Young's modulus and shear modulus in ocular tissues. OCE has been utilised to assess corneal stiffness in keratoconus, lens elasticity in presbyopia and cataract formation, and iris biomechanical changes under different lighting conditions. The studies demonstrated that OCE could detect subtle biomechanical changes associated with ocular diseases and measure treatment efficacy, such as collagen crosslinking for keratoconus management. The findings highlight the potential of OCE to enhance clinical diagnostics and patient care by providing detailed insights into the biomechanical properties of ocular tissues. However, variability in measurement techniques, the complexity of the method and reliance on animal models limit the current clinical translation of OCE. Standardised measurement protocols and further development andin vivovalidation are needed to overcome these barriers. OCE shows promise as a valuable non-invasive tool for high-resolution assessments of tissue biomechanics, which can subsequently support the diagnosis and management of ocular diseases. Future research should focus on standardising OCE methods and integrating them into clinical practice to fully realise their potential in improving patient outcomes.

Optical Coherence Elastography Measures Mechanical Tension in the Lens and Capsule

Lens tension is essential for accommodative vision but remains difficult to measure with precision. Here, we present an optical coherence elastography (OCE) technique that quantifies both tension and elastic modulus in the lens capsule and underlying tissue. This method derives mechanical parameters from surface wave dispersion across a critical frequency range of 1-30 kHz. Using isolated lenses from six-month-old pigs, we measured intrinsic anterior capsular tensions of 0-20 kPa and posterior capsular tensions of 40-50 kPa, induced by intra-lenticular pressure at the cortical surface. The mean shear moduli of anterior and posterior capsules were 630 kPa and 400 kPa, respectively, nearly 100-fold greater than that of the cortical tissues, where tensions were below 1 kPa. Biaxial zonular stretching (∼4% strain) increased anterior capsular tension by 67 kPa, with a low uncertainty of only 2 kPa. This optical method holds significant promise for diagnosing and managing accommodative dysfunctions through lens mechanics assessment in clinical settings. STATEMENT OF SIGNIFICANCE: Optical coherence elastography (OCE) is a rapidly advancing imaging modality, but its applications have been limited to stiffness measurements. This work represents a significant innovation by extending OCE capabilities to include force and stress quantification, broadening its potential applications in biomedical and clinical contexts. The ability to measure in situ capsular tension in the eye lens is a major breakthrough, as capsular tension is essential for transferring zonular fiber forces to the lens tissue during accommodation-a process critical for vision. This study provides quantitative insights into the mechanical mechanisms of accommodation and holds strong promise as a clinical tool for assessing lens tissue mechanics, addressing a capability gap in current clinical practice.

Shear Wave Optical Coherence Elastography Imaging by Deep Learning

Quantifying ocular tissue mechanical properties is pivotal for elucidating eye disease etiology and progression. Optical coherence elastography (OCE), leveraging high-resolution optical coherence tomography, promises tissue stiffness assessment. Traditional OCE relies on data processing of the time-of-flight method and encounters challenges like low repeatability. Our study presents an optimized data processing workflow integrating OCE with deep learning to predict ocular tissue biomechanical properties. The concentration prediction network (CPN), a 3D convolutional neural network, predicts sample's concentrations and calculates the Young's modulus based on the relationship between agar concentration and Young's modulus from mechanical testing. The CPN showed high accuracy, with a mean absolute error of 0.028 ± 0.036 for training and 0.036 ± 0.024 for testing data of agar phantoms. In situ porcine corneas with various intraocular pressures was measured, yielding corneal biomechanical distribution via deep learning method. This approach enhances the efficiency of OCE and underscores potential clinical applications in ophthalmology.

Mechanical Properties of Eye Lens Cortical and Nuclear Membranes and the Whole Lens

Purpose

To elucidate the mechanical properties of the bovine lens cortical membrane (CM), the nuclear membrane (NM) containing cholesterol bilayer domains (CBDs), and whole bovine lenses.

Methods

The total lipids (lipids plus cholesterol) from the cortex and nucleus of a single bovine lens were isolated using the monophasic methanol extraction method. Supported CMs and NMs were prepared from total lipids extracted from the cortex and nucleus, respectively, using a rapid solvent exchange method and probe-tip sonication, followed by the fusion of unilamellar vesicles on a flat, freshly cleaved mica surface. Topographical images and force curves for the CMs and NMs were obtained via atomic force microscopy (AFM) in a fluid cell. Whole bovine lenses were affixed to custom-built glass Petri dishes, and an AFM was used to obtain force curves. Force curves were analyzed to estimate the breakthrough force, membrane stiffness (KA and Em), and lens stiffness (EL).

Results

The NMs containing CBDs exhibited significantly lower breakthrough force, KA, and Em than the CMs without CBDs. The Em values for CMs and NMs were significantly higher than the EL for the whole lens.

Conclusions

The significantly higher stiffness of the CM and NM compared to the stiffness of the whole lens suggests that slight modulation in CM and NM composition may play a crucial role in altering the overall lens stiffness. Furthermore, the NMs containing CBDs were less stiff than CMs without CBDs, suggesting that CBDs decrease lens membrane stiffness and possibly protect against lens hardening and presbyopia.

Optical Coherence Elastography Measures Mechanical Tension in the Lens and Capsule in situ

Lens tension is essential for accommodative vision but remains challenging to measure with precision. Here, we present an optical coherence elastography (OCE) technique that quantifies both the tension and elastic modulus of lens tissue and capsule. This method derives mechanical parameters from surface wave dispersion across a critical frequency range of 1-30 kHz. Using isolated lenses from six-month-old pigs, we measured intrinsic anterior capsular tensions of 0-20 kPa and posterior capsular tensions of 40-50 kPa, induced by intra-lenticular pressure at the cortical surface. Young's modulus ( E ) was 1.9 MPa for anterior capsules and 1.2 MPa for posterior capsules. Tensions in cortical tissue ( E ∼ 10 kPa ) were below 1 kPa. Biaxial zonular stretching (~4% strain) increased anterior capsular tension from near zero to 64 kPa. This acousto-optical method holds significant promise for diagnosing and managing accommodative dysfunctions through lens mechanics assessment in clinical settings.

In Vivo Imaging and Evaluation of Corneal Biomechanics After Corneal Transplantation by Optical Coherence Elastography

Postoperative corneal biomechanical evaluation is of great significance in clinical monitoring and management since corneal transplantation is one of the main methods to improve visual function. In this paper, we propose an OCE system based on a small ultrasound transducer to realize the in vivo detection of postoperative corneal elasticity in different directions. It was first validated and analyzed by different agar, and then the elasticity changes in normal cornea and post-transplant corneal implants and implant beds were further investigated. Compared with normal corneas, the shear wave velocity of the postoperative cornea decreased from 7.42 ± 1.71 m/s to 4.95 ± 0.35 m/s. Meanwhile, the shear wave velocity of the corneal implant bed was lower than that of the implanted sheet. Therefore, this study reports the first biomechanical measurement of corneal grafts based on the OCE technique, which might provide a potential tool for the postoperative evaluation of clinical patients.

Biomechanical and histological changes associated with riboflavin ultraviolet-A-induced CXL with different irradiances in young human corneal stroma

Keratoconus (KC) is a degenerative condition affecting the cornea, characterized by progressive thinning and bulging, which can ultimately result in serious visual impairment. The onset and progression of KC are closely tied to the gradual weakening of the cornea's biomechanical properties. KC progression can be prevented with corneal cross-linking (CXL), but this treatment has shortcomings, and evaluating its tissue stiffening effect is important for determining its efficacy. In this field, the shortage of human corneas has made it necessary for most previous studies to rely on animal corneas, which have different microstructure and may be affected differently from human corneas. In this research, we have used the lenticules obtained through small incision lenticule extraction (SMILE) surgeries as a source of human tissue to assess CXL. And to further improve the results' reliability, we used inflation testing, personalized finite element modeling, numerical optimization and histology microstructure analysis. These methods enabled determining the biomechanical and histological effects of CXL protocols involving different irradiation intensities of 3, 9, 18, and 30 mW/cm2, all delivering the same total energy dose of 5.4 J/cm2. The results showed that the CXL effect did not vary significantly with protocols using 3-18 mW/cm2 irradiance, but there was a significant efficacy drop with 30 mW/cm2 irradiance. This study validated the updated algorithm and provided guidance for corneal lenticule reuse and the effects of different CXL protocols on the biomechanical properties of the human corneal stroma.

Spatial mapping of corneal biomechanical properties using wave-based optical coherence elastography

Quantifying the mechanical properties of the cornea can provide valuable insights into the occurrence and progression of keratoconus, as well as the effectiveness of corneal crosslinking surgery. This study presents a non-contact and non-invasive wave-based optical coherence elastography system that utilizes air-pulse stimulation to create a two-dimensional map of corneal elasticity. Homogeneous and dual concentration phantoms were measured with the sampling of 25 × 25 points over a 6.6 × 6.6 mm2 area, to verify the measurement capability for elastic mapping and the spatial resolution (0.91 mm). The velocity of elastic waves distribution of porcine corneas before and after corneal crosslinking surgery were further mapped, showing a significant change in biomechanics in crosslinked region. This system features non-invasiveness and high resolution, holding great potential for application in ophthalmic clinics.

In-vivo characterization of scleral rigidity in myopic eyes using fundus-pulsation optical coherence elastography

The sclera plays an important role in the structural integrity of the eye. However, as myopia progresses, the elongation of the eyeball exerts stretching forces on the posterior sclera, which typically happens in conjunction with scleral remodeling that causes rigidity loss. These biomechanical alterations can cause localized eyeball deformation and vision impairment. Therefore, monitoring scleral rigidity is clinically important for the management and risk assessment of myopia. In this study, we propose fundus pulsation optical coherence elastography (FP-OCE) to characterize posterior scleral rigidity in living humans. This methodology is based on a choroidal pulsation model, where the scleral rigidity is inversely associated with the choroidal max strain obtained through phase-sensitive optical coherence tomography (PhS-OCT) measurement of choroidal deformation and thickness. Using FP-OCE, we conducted a pilot clinical study to explore the relationship between choroidal strain and myopia severity. The results revealed a significant increase in choroidal max strain in pathologic myopia, indicating a critical threshold beyond which scleral rigidity decreases significantly. Our findings offer a potential new method for monitoring myopia progression and evaluating therapies that alter scleral mechanical properties.

Optical coherence elastography and its applications for the biomechanical characterization of tissues

The biomechanical characterization of the tissues provides significant evidence for determining the pathological status and assessing the disease treatment. Incorporating elastography with optical coherence tomography (OCT), optical coherence elastography (OCE) can map the spatial elasticity distribution of biological tissue with high resolution. After the excitation with the external or inherent force, the tissue response of the deformation or vibration is detected by OCT imaging. The elastogram is assessed by stress-strain analysis, vibration amplitude measurements, and quantification of elastic wave velocities. OCE has been used for elasticity measurements in ophthalmology, endoscopy, and oncology, improving the precision of diagnosis and treatment of disease. In this article, we review the OCE methods for biomechanical characterization and summarize current OCE applications in biomedicine. The limitations and future development of OCE are also discussed during its translation to the clinic.

The lens capsule significantly affects the viscoelastic properties of the lens as quantified by optical coherence elastography

The crystalline lens is a transparent, biconvex structure that has its curvature and refractive power modulated to focus light onto the retina. This intrinsic morphological adjustment of the lens to fulfill changing visual demands is achieved by the coordinated interaction between the lens and its suspension system, which includes the lens capsule. Thus, characterizing the influence of the lens capsule on the whole lens’s biomechanical properties is important for understanding the physiological process of accommodation and early diagnosis and treatment of lenticular diseases. In this study, we assessed the viscoelastic properties of the lens using phase-sensitive optical coherence elastography (PhS-OCE) coupled with acoustic radiation force (ARF) excitation. The elastic wave propagation induced by ARF excitation, which was focused on the surface of the lens, was tracked with phase-sensitive optical coherence tomography. Experiments were conducted on eight freshly excised porcine lenses before and after the capsular bag was dissected away. Results showed that the group velocity of the surface elastic wave, V, in the lens with the capsule intact (V=2.55±0.23 m/s) was significantly higher (p < 0.001) than after the capsule was removed (V=1.19±0.25 m/s). Similarly, the viscoelastic assessment using a model that utilizes the dispersion of a surface wave showed that both Young’s modulus, E, and shear viscosity coefficient, η, of the encapsulated lens (E=8.14±1.10 kPa,η=0.89±0.093 Pa∙s) were significantly higher than that of the decapsulated lens (E=3.10±0.43 kPa,η=0.28±0.021 Pa∙s). These findings, together with the geometrical change upon removal of the capsule, indicate that the capsule plays a critical role in determining the viscoelastic properties of the crystalline lens.