Depth-Dependent Corneal Biomechanical Properties in Normal and Keratoconic Subjects by Optical Coherence Elastography

Compare depth-resolved biomechanical properties in normal and keratoconic corneas in live human subjects using optical coherence elastography (OCE). In a prospective series of normal and keratoconus (KC) eyes, a corneal perturbation was applied by a custom swept-source OCE system using a transparent flat lens coupled to force transducers. Cross-correlation was applied to track frame-by-frame OCT speckle displacement. Regional displacements for the anterior and posterior stroma were plotted in force versus displacement ( ) graphs. A spatial biomechanical property ratio ( ) was defined by dividing the maximum total displacement by the maximum force for the anterior ( ) and posterior cornea ( and was compared between normal and KC groups with the Mann-Whitney test. Area under the receiver operating characteristics curve (AUROC) for differentiating normal and KC eyes was calculated for , k , and thinnest point of corneal thickness (TPCT). Thirty-six eyes were analyzed (21 eyes of 12 normal subjects and 15 KC eyes of 12 subjects). The for the normal group was 1.135 ± 0.07 (mean ± standard deviation) and 1.02 ± 0.08 for the KC group ( < 0.001), indicating a relative deficit in anterior stromal stiffness in KC eyes. AUROC was 0.91 for / , 0.95 for k , and 1 for TPCT. Significant differences in depth-dependent corneal biomechanical properties were observed between normal and KC subjects. OCE was applied for the first time to human KC subjects and revealed alterations in the normal anterior-to-posterior stromal stiffness gradient, a novel and clinically accessible disease biomarker.