Computational and analytical modeling of eye refractive surgery.

Abstract

As the number of corneal refractive procedures increases annually, concerns about their long-term stability and predictability have become the center of attention in the ophthalmic community. This thesis focuses on developing quantitative biomechanical models of the cornea that will overcome shortcomings of previous models and incorporate new observations of corneal elastic properties. Our intent is to provide a more accurate model of the corneal structure to guide current and future developments. The second chapter shows that neural networks could rapidly prototype practical solutions to obtain a better estimate of the average corneal power using the contrast and image size parameters provided by the topographic systems. After establishing improved measurements of the corneal shape the thesis focuses on the development of various corneal models. The analytical model proposed shows that geometric optics, corneal structural properties and surgical nomograms could be used to gain a better understanding of corneal response to surgical interventions. The predictions of this model are closer to the values provided by the published nomograms and clinical data than that obtained by the traditional geometric model. Three surgical procedures (Ultrafast Laser-Automated Lamellar Keratomileusis, Corneal Transplant and Intrastromal Refractive Keratectomy) were simulated using the finite element method. A new formulation was developed that simulates the changes on corneal curvature after refractive surgery when the stiffness inhomogeneities across the corneal thickness are considered. It has been shown that the predictability of the surgical outcome is improved when the stiffness inhomogeneities and nonlinearities of the deformations are included in the finite element simulations. Moreover, a finite element formulation has been developed first time to characterize the intrastromal refractive keratectomy procedure. An inhomogeneous (small displacements) model was identified as an acceptable representation of the corneal biomechanical response to this novel technique. The formulations developed and clinically tested in this study were able to calculate how the curvature changes are mediated by alterations in the stress-strain relationship of the corneal tissue. Non-uniform stress-strain relations found at the laser-treated zones are among the most important results of the model. In addition, the model verified that the cornea weakens centrally after intrastromal treatment of the mid-periphery.