Corneal Viscous Properties Cannot Be Determined From Air-Puff Applanation

Mathew Francis, Himanshu Matalia, Rudy M. M. A. Nuijts, Bart Haex, Rohit Shetty, Abhijit Sinha Roy*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


PURPOSE: To assess whether corneal viscous properties are measureable with air-puff applanation in patients.

METHODS: The study had 312 normal eyes, 107 fellow eyes of patients with keratoconus, and 289 keratoconic eyes. The Corvis ST (Oculus Optikgerate 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 viscoelastic 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 (mu c).

RESULTS: 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.

CONCLUSIONS: No significant corneal viscous response was detected in patients who had air-puff applanation.

Original languageEnglish
Pages (from-to)730-736
Number of pages8
JournalJournal of Refractive Surgery
Issue number11
Publication statusPublished - Nov 2019



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