Young’s Modulus in Normal Corneas and the Effect on Applanation Tonometry

Objectives. To determine the statistically normal range of corneal Young’s modulus in young healthy eyes in vivo, and to establish if this variation has a clinically significant influence on intraocular pressure (IOP) measurement using applanation tonometry. Methods. Central corneal curvature, central corneal thickness (CCT), and applanation IOP (Goldmann tonometer) were measured using standard clinical techniques in one eye of 100 normal human subjects (22.0 ± 2.9 years) in vivo. The Orssengo-Pye algorithm was used to calculate the corneal Young’s modulus of these experimental subjects, and to produce a theoretical model of potential errors in Goldmann applanation tonometry estimates of IOP due to variations of Young’s modulus and CCT. Results. Corneal Young’s modulus was 0.29 ± 0.06 MPa [95% confidence interval (CI) 0.17 to 0.40 MPa]. According to the Orssengo-Pye model, the relationship between Young’s modulus and the error in applanation IOP is linear; the slope was 23 mm Hg per MPa. An increase from the minimum to the maximum value of the calculated limits of agreement (95% CI) of Young’s modulus caused a variation in applanation IOP of 5.35 mm Hg. The anticipated error at the extremes of the limits of agreement (95% CI) of CCT was similar at 4.67 mm Hg. Conclusion. Physiological variations in corneal Young’s modulus may cause clinically significant errors in Goldmann applanation tonometry estimates of IOP.