Ocular Pulse Elastography: Imaging Corneal Biomechanical Responses to Simulated Ocular Pulse Using Ultrasound

Purpose: In vivo evaluation of corneal biomechanics holds the potential for improving diagnosis and management of ocular diseases. We aimed to develop an ocular pulse elastography (OPE) technique to quantify corneal strains generated by naturally occurring pulsations of the intraocular pressure (IOP) using high-frequency ultrasound. Methods: Simulated ocular pulses were induced in whole porcine and human donor globes to investigate the effects of physiologic variations in baseline IOP, ocular pulse amplitude, and frequency on corneal strains. Ocular pulse-induced strains were measured in additional globes before and after UVA-riboflavin-induced corneal crosslinking. The central cornea in each eye was imaged with a 50-MHz ultrasound imaging system and correlation-based speckle tracking of radiofrequency data was used to calculate tissue displacements and strains. Results: Ocular pulse-induced corneal strains followed the cyclic changes of IOP. Both baseline IOP and ocular pulse amplitude had a significant influence on strain magnitude. Variations in pulse frequency within the normal human heart rate range did not introduce detectable changes in corneal strains. A significant decrease of corneal strain, as quantified by the OPE technique, was observed after corneal crosslinking. The extent of corneal stiffening (i.e., strain reduction) seemed to correlate with the initial strain magnitude. Conclusions: This ex vivo study demonstrated the feasibility of the OPE method to quantify corneal strains generated by IOP pulsation and detect changes associated with corneal crosslinking treatment. Translational Relevance: Integrating in vivo measurement of IOP and ocular pulse amplitude, the OPE method may lead to a new clinical tool for safe and quick biomechanical evaluations of the cornea.