BULLETIN O F NIATHEMATICAL BIOPHYSICS VOLUI~IE 30, 1968

A THEORETICAL MODEL OF THE CORNEA FOR U S E I N S T U D I E S OF T O N O M E T R u

9 C. C. Mow* The RAND Corporation, Santa Monica, California

A t h e o r e t i c a l m o d e l of t h e c o r n e a b a s e d o n c o r n e a l d i m e n s i o n s a n d r e p o r t e d p r o p e r t i e s is p r e s e n t e d i n t h i s p a p e r . I t is s h o w n t h a t b e c a u s e o f large differences i n t h e t h i c k n e s s e s of the Bowman's and Descemet's membranes and the stroma, and because of the reported l a r g e differences i n t h e elastic p r o p e r t i e s o f t h e layers, a s a n d w i c h - s h e l l m o d e l is a g o o d a p p r o x i m a t i o n for t h e s t u d y o f c o r n e a l d e f o r m a t i o n . T h e t h e o r y is a p p l i c a b l e for a p p l a n a t i o n t o n o m e t r y . A set o f e q u i l i b r i u m e q u a t i o n s b a s e d o n R e i s s n e r ' s t h e o r y is given. Shell p a r a m e t e r s w h i c h d e t e r m i n e t h e b e h a v i o r of shells are e x p r e s s e d i n t e r m s o f t h e c o r n e a l p r o p e r t i e s a n d d i m e n s i o n s . N u m e r i c a l e x a m p l e s w h i c h s h o w t h e effects o f c o r n e a l p a r a m e t e r s o n t h e s t r e s s r e s u l t a n t s d u e t o i n t r a o c u l a r p r e s s u r e arc also g i v e n .

I. Introduction. Among the many methods for diagnosing glaucoma, the one most frequently used is tonometry. The mechanical principle of tonometers has been studied in detail (Gloster, 1966 and Draeger, 1966) and therefore will not be discussed here. Rather, we are concerned with identifying some of the features of the cornea that might influence the readings of the tonometer (that is, cause displacements in the Sehiotz tonometer and applied force in the applanation tonometry) and hence the interpretation of the intraocular pressure. A brief survey of the ophthalmic literature showed that nearly all the earlier theoretical models of the eye used in the study of tonometry have assumed the eye to be a simple membrane structure. Goldmann (1956) advanced a
* A n y views expressed in this paper are those of the author. They should n o t be interpreted as reflecting the views of the RAlqD Corporation or the official opinion or policy of a n y of its governm e n t a l or private research sponsors. Papers are reproduced b y The R A N D Corporation as a courtesy to members of its staff. 437

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C.C. MOW

model in which the eye was assumed to consist of two concentric membranes separated b y incompressible fluids, and with this assumption qualitatively determined the meaning of applanation tonometry. More recently, Schwartz et al. (1966) used a homogenous, isotropie, shallow-shell theory to study corneal deformation. However, there is a clear need for a better model for use in the analysis of corneal deformation which in turn would lead toward a better understanding of tonometry. This paper presents a more realistic model for the cornea which, hopefully, will be flexible enough to contain many parameters of the cornea and still be amenable to analysis. This is the so-called "sandwich shell" model. It should be noted at this point that the "sandwich shell" theory was first derived b y Reissner in 1949 and has been in existence for almost t w e n t y years. I I . Basis for the Model. In the following, we shall discuss the basis upon which the sandwich-shell model was chosen for the cornea. Figure 1 shows a horizontal cross section of an eye, with some of the important parts located and identified. Figure 2 shows the structure of the cornea. It is apparent from Figure 1 that an eye is an extremely complex

MODEL OF THE CORNEA

439

structure in the engineering sense. However, the scope of this study is fairly limited, and we will be concentrating on the corneal portion of the eye since this is where tonometers are usually applied.

Description of the Cornea. The cornea is transparent. Seen from the front, it appears to be elliptical (approximately 12 mm in the horizontal meridian and 11 mm in the vertical), while from behind, it appears circular. This difference is due to the fact t h a t the sclera and conjunctiva overlap the cornea anteriorly, more above and below than laterally. The normal radius of the curvature of the anterior surface is 7.86 m m with a standard deviation of 0.26 ram. The posterior curvature is ~ 7.00 ram.

Figure 2 The cornea is slightly thicker along the periphery where it is ~ 1 m m thick t h a n at the center where it is N0.58 ram. There are five microscopically distinguishable layers which are described briefly (Wolff, 1948 and Maurice, 1962) below: 1. The epithelium (outermost layer) is about 50 to 100 ~z (~z = 10 -3 mm) thick and consists of five or six layers of cells. No mechanical properties of the epithelium have been described in the ophthalmic literature. 2. Bowman's membrane is a fine layer of basement membrane which lies directly under the basal cells of the epithelium. I t is a thin, structureless sheet about 12 ~zthick and is described as an "elastic" lamina.
6--B.M,B.

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C.C. MOW

3. The stroma (substantial propia) makes up about 90 percent of the thickness of the cornea. I t is composed of sheets of eollageneous material--the stromal lamellae which lie parallel to the surface. The lamella bands are parallel to each other, b u t those of alternating layers are orthogonal to each other. The mechanical properties of the stroma, that is, shear strength and cohesive strength, have been described b y Maurice (1962) and are of great importance. The stroma has virtually no resistance to shear forces. I f an isolated cornea is held between finger and thumb, the two faces m a y slide upon one another quite freely. Stroma separates readily into a cleavage plane parallel to its surfaces. When stretched in a direction perpendicular to the corneal surface, sections of stroma do not rupture immediately but return elastically to their original thickness. Schwartz et al. (1966) reports the nonlinear behavior of an excised cornea under compressional test (that is, when the cornea is loaded perpendicular to its surface, its displacement is not linearly proportional to the load applied). Furthermore, it was estimated b y Schwartz that the modulus of elasticity of the stroma is at least two or three orders of magnitude lower than that of the outer layers (Bowman's membrane and the epithelium).~ 4. Dcscemet's membrane (posterior elastic membrane) described in Wolff as a strong, structureless and very resistant membrane. I t is about 5 to 10 ~ in thickness. 5. The endothelium is the most posterior layer of the cornea and consists of a single layer of flat epitheliM-like cells about 5 f~ thick. As can be seen, the mechanical properties of the five corneal layers described above are quite qualitative rather than quantitative, and there appears to be no detailed information available on these properties. There is, however, ample information on the ocular rigidity, K, an eye constant which is used in tonometry for the determination of the relationship of pressure and volume,:~ b u t it is not useful for the detailed modeling of a cornea. The cornea has the following typical dimensions (see Fig. 3): 1. Radius of curvature of posterior surface, R~ ~ 7.0 mm 2. l~adius of curvature of anterior surface, R~ ~ 7.0 mm
t T h i s is a n i m p o r t a n t f a c t o r in t h e choice of t h e s a n d w i c h m o d e l for t h e cornea. A n y evidence, e i t h e r s u p p o r t i n g or c o n t r a d i c t i n g t h e s t a t e m e n t , w o u l d be w e l c o m e d b y t h e a u t h o r . $ T h e coefficient o f o c u l a r rigidity, K, is i m p o r t a n t for t h e d e t e r m i n a t i o n o f t h e p r e s s u r e - v o l u m e r e l a t i o n s h i p o f a n eye o n l y in a m a c r o s c o p i c sense. I t is defined as: K = In Pt/Po Vt w h e r e pt is t h e i n t r a o c u l a r p r e s s u r e w h e n t h e t o n o m e t e r is applied; Po is t h e u n d i s t u r b e d inr p r e s s u r e ; a n d Vt is t h e v o l u m e of fluid d i s p l a c e d b y t h e t o n o m e t o r .

M O D E L OF T H E COR17EA

441

3. Horizontal radius, r o H 6.0 m m 4. Combined thickness of epithelium

t* H 5 0 ~ lOO

and

Bowman's

membrane,

5. Thickness of Bowman's membrane, t o ~ 10 6. Combined thickness of I)escemet's membrane

t~ ~ 10-15

and

endothelium,

7. Thickness of the stroma, h c H 700 N 800 8. The mean radius of curvature,/~ H 7.45 m m

ra

Figure 3
Characteristic S h e l l P a r a m e t e r s . Using the above information about the cornea, we shall now examine some of the characteristic parameters t h a t are normally used to characterize a shell structure. The parameters used to classify the type of shell are (1) the ratio of shell thickness to the mean radius of curvature, i//~, and (2) the ratio of the shell height to the base diameter, H / 2 r o (a parameter used to determine the shallowness of the shell). Using the dimensions given above, we find t h a t a typical cornea has the following values of t//~ and H/2ro: i 0.86 - -- 0.115 R 7.45

H 1 2r--~ ~

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C . C . MOW

where t is the total thickness of the cornea, ~ = R o - R~. F r o m these values, it can be seen that the cornea is not a membrane-type shell, nor is it a very thin shell (usually described as a shell with ~//~ < -2!6), nor is it a shallow shell (usually described as a shell with H / 2 R o < }) (Reissner, 1946). I n addition to the geometric parameters of the cornea, we must consider also the different properties of the various layers, the nonlinearity, and the viscoelastic behavior of the cornea. I t becomes readily apparent t h a t no one model that we can construct will include all of these geometric and physical properties and still be amenable to analysis. However, we believe that Reissner's sandwich-shell theory will adequately take into account most of the properties of the cornea and can thus be used to develop a satisfactory model. To apply this theory, we have made the following assumptions: 1. 2. 3. 4. 5. The The The The The cornea is composed of three layers (two face layers and one core layer) properties of the two face layers differ from those of the core layer value of t//~ is small two face layers have the same thickness material of the cornea is elastic and linear

We shall Mso use the following properties of the cornea, as discussed earlier: 1. The ratio of thickness of outer or inner layer to stroma, to. J h c ~,, 0 (10 - t ~ 10 -2) 2. The ratio of u modulus of the stroma to the face layers (Schwartz, 1966) E c / E f ,,, 0(10 -2 - 10 -3) 3. The core layer (stroma) appears to have no in-plane shear resistance (Maurice, 1962) Using the above assumptions and the physical properties of the cornea, we find that the cornea can be approximated b y Reissner's sandwich shell theory which is based on the following assumptions:
1. t / R << 1

2. (E~t)/(Ech) >> 1

3. t/h

<< 1

4. There is small deformation 5. Each layer, that is face and core, is elastic The corneal properties that have been assumed satisfy Reissner's assumptions 1, 2 and 3, and the requirement for small deformation m a y be satisfied for applanation tonometry. The last assumption m a y not be realistic for corneas; however, if the model presented herein is used only to study applanation tone-

MODEL

OF THE

CORNEA

443

merry, then, because of the small deformation involved in applanation, the cornea m a y very well be deformed within the linear portion of its force-versusdisplacement curve. w And finally, the viscoelastic behavior of the cornea might not be important in tonometry because of the short loading duration that tonometry requires. I] Having determined that the use of Reissner's sandwich-shell model for the cornea appears to be justified, we shall next present the basic equations that can be used to determine the effects of the corneal parameter on the deformation of the cornea. Also, we shall show the effect of the corneal parameter on the stresses due to intraoeular pressure in the various layers of the cornea. In this section we shall present the equations of equilibrium for the sandwich-type shell and then relate the parameters in the shell theory to those of the cornea. Using the theory for a sandwich shell of revolution, the derivation of which is given b y Reissner (1949), if we assume that the cornea is a segment e r a sphere and the loads are axially symmetric, then the equation of equilibrium and the relationship between displacement and stress for a sandwich shell in spherical polar coordinates apply. The equations of equilibrium for a sandwich shell in (r, 0, ~) coordinates (see Fig. 4) are

III. ;Basic Equations.

d(sin q~N~)
R d~o d(sin ~0Qo) R d~0 d(sin ~ Mr) R d~0

No d (sin ~)
sin ~ \

R d-----~ + sin ~ R

(~

+ p~

= 0 0

(1)

[.No + HO] + sin ~ / =

!

(2)
(3)

Ms d (sin ~) R d---~ sin ~(m o - Qo) = 0

where Po, q and m o are the stress resultants of external loads. to the externally applied loads as follows:

They are related

poz

(4)

where Po~ and p ~ are external loads acting in the ~o direction on the upper and lower membranes, and

q=

1+--7)

q,

wThese points can be clarified by experiments. II Viscoelasticity can be incorporated into the layers without undue difficulties; it is more i m p o r t a n t to know just what viscoelastic model is appropriate for the cornea before incorporating it into the shell theory.

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C. C. MOW

~.O

de

( a ) Seometry

(b) Coordinates and dimensions

/
N~

A~?./.

/q~~__~____.~X/-,
Nr

y , c , S,re,,re,u,tan,,,n,oce
layer s and core layer

N r e#.,

Figure 4

M O D E L OF T H E C O R N E A

445

where qu and qz are normal loads acting on upper and lower membranes and

The radial normal stress in the middle plane is related to the moments and s by equation (7), which is peculiar to sandwich-shell theory:
arrm q-

(h q- t)tl (Me + M~) - s = 0

(7)

where
s =-~ 1 + ~ / qu1 2R qz "

(8)

The relationship between stress and displacement relationship for the shell is given by the following equations:
Q~ dw (h + t)Gc = fi + R dcp u R

(9) (10) (11) (12) (13)

(1 + 89 Nr - (v - 89 JVe = C* (1 + 89 0(v89

(-F'd~ w (h + t___~) ) du + -R + 12REc q

( u d(sin~) w (h-r-t)) o = C* s i n v ~ + ~ + ~R-E~ q 1 + E--~ s)

(I + 2 ) M

_ (v _ 2t)Me = D , ( dfl

(1 + 2,)M o where

(v-

2)M~ = D*

(nil_ d(sin ~) 1 ) Si ~o R d ~ + E - ~ s

C* = 2tE s D* = 89t(h + t)2Ef

;~ =

l (h + t)t E~
2 R2 Ec

and R is the radius of the curvature; t is the thickness of the membrane; h is the thickness of the core; u and w are the displacements in the ~0and r directions, respectively; v is the Poisson ratio; E I and E c are the Young's modulus of the face membrane and core, respectively; G c is the shear modulus of the core; and fl is the slope of the deflection.

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C.C. MOW

Equations (1) through (3) and equations (9) through (13) provide eight equations to solve the eight unknowns given below. 1. The direct-stress resultant in the 0 direction: Ne = 1+ 2R ] -h70u 1 2R ] Ne~

(Neu and Noz denote the direct-stress resultants in the upper and lower membranes, respectively) 2. The direct stress resultant in the ~o direction: N o = (1 +

h + ti

2R ] -N~u +

(1

h_+ t]

2R ] N ~

(1Vou and N~z are defined similarly to Neu and N0z above) 3. The transverse-shear-stress resultant:

(ar~ and a~l are the shearing stresses acting at the upper and lower membrane, respectively) 4. The stress couple for the composite shell:

M8

h+ t

[(1 + --2R-] N~

h t~

- (1

h + t~ Noz]

"2-R]

5. The slope of the deflection, fl 6. The displacement in the ~ and r directions, u and w.
I V . Stresses in the Cornea Due to Intraocular Pressure. I t is apparent that in order to determine the values of the eight unknowns listed in Section III, we must solve the eight simultaneous equations--a task which entails much effort. However, it is a simple matter to use these equations to determine the stresses due to the intraocular pressure in the various layers of the cornea. For this purpose, we shall assume t h a t the eye is a complete sphere subjected to a load of only the intraocular pressure, pc. The complete-sphere assumption is satisfied if the stresses obtained are used only to estimatethose near the central portion of the cornea. The results will not be valid, however, for stresses near the sulcus sclera, because of the differences in the properties of the cornea and the sclera. As a result of the above assumption, all quantities are independent of ~;

MODEL OF THE CORNEA

447

therefore, we can solve for the unknown by a set of algebraic equations. the only load is qz, then
2o~, = O, qu = O, m ~ = O.

Since

By reasons of symmetry, fl, u and/9+ are zero also (fl is the slope of the deflection; u, the displacement in the W direction; and p~, the transverse shear in the direction). From equation (1), N~, = No = No. (14) Substitution of equation (14) into equationS(2) gives
N O -- P ~ 2

(15)

which is the familiar expression for the tension in a sphere subjected to internal pressure Po. We shall discuss this result later in this paper. Equations (3) and (7) are simplified to the following relationships:
M~ = Me = Mo, arrm = S 2 R ( h + t)

Mo

(16)

From equation (8), s = -- P-2~ 2 Using equations (12) and (13) we obtain
1 (h + t ) R A po M~ = -21+2A-v Po 2 1 -{- 22 -- V "

(17)

(18)
(19)

(Yrrm ~

1 -- v

E q u a t i o n s (15), (18) and (19) give the overall-stress resultants in the composite shell. The direct-stress resultant is Mso given, that is, N o = ( p o R / 2 ) which should not be surprising since the composite shell must also satisfy the overall equilibrium condition. Having determined the above quantities, we m a y use the definition for N, M to determine the stresses in the membranes. I n a dimensionless form they are as follows:

No~ = --Rpo =

(l

h 2R t) 2 (1 - 1,) +
v) (20)

+ h + t] (1 + 2 2 4 (1 + 2R !

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C.C. MOW

h+t~
Rpo 4 + 2a -

,
rrm

= ~rrm
po =

1
"2--k ! 1+

(22)

I n addition to these stress r e s u l t a n t s a n d t h e stress a t midplane, we can also d e t e r m i n e t h e radial d i s p l a c e m e n t w, a n d t h e stress d i s t r i b u t i o n across the stroma: w (1 - v) R po w* . . . . (23) R 4 t EI

_~O-'ff ~rrm

---~h

1 -

--

(24)

E q u a t i o n s (20) t h r o u g h (24) can n o w be used to c o m p u t e t h e stresses in t h e m e m b r a n e s , t h e radial d i s p l a c e m e n t s a n d t h e v a r i a t i o n of t h e radial n o r m a l stress across t h e thickness of the cornea. I t m i g h t be of i n t e r e s t here to r e c a p i t u l a t e the m e a n i n g s of t h e p a r a m e t e r s t h a t influence the stresses in t h e p r e s e n t context. I n e q u a t i o n s (20) t h r o u g h (24) t h e i m p o r t a n t p a r a m e t e r s are 1. T h e ratio of o n e - h a l f t h e t o t a l thickness of t h e cornea to t h e m e a n radius o f c u r v a t u r e of t h e cornea, h* = (h t ) / 2 R 2. T h e Poisson r a t i o of t h e cornea, v, which lies in t h e r a n g e 0 < v _< 0.5 3. A dimensionless p a r a m e t e r , 2, d e t e r m i n e d b y t h e dimensions of t h e m e m b r a n e s a n d s t r o m a as well as t h e r a t i o of t h e Y o u n g ' s m o d u l u s of t h e m e m b r a n e a n d s t r o m a , ~ = 89 + t)(EI/R2Ec) 4. T h e thickness of t h e m e m b r a n e , t 5. T h e thickness of t h e s t r o m a , h. T h e o r d e r - o f - m a g n i t u d e e s t i m a t e s for these p a r a m e t e r s according to Section I I , are as follows: F o r a t y p i c a l cornea /~ ~- 7.43 _+ 0.26 ram, or 7.17 < R <_ 7.69 ( m e a n radius),

0.55 m m < h t < 0.85 m m (range of the c o m b i n e d thicknesses of stroma and membrane) h h* = - 2R or 3.6 10 -2_< h*_< 5.9 10 -2 103 (Schwartz, 1966)

E * = E t ~ 102 Ec t*---

t ~ 2.0 10-3 (t ~ 15 ~ i s u s e d ) . R =

M O D E L OF T H E C O R N E A

449

Using the above quantities, we find t h a t ~ has the following rather large range of values: 7.2 10 -S < ~ < 1.18 x 10 -1 . I t appears t h a t the dimensions of the cornea are well known, but information concerning the elastic properties of the cornea is grossly lacking.

V. Numerical Computation. The preceding section has presented a set of equations t h a t can be used to compute stresses in the various layers of the cornea as well as the range of values for the parameters t h a t we have estimated using the information available. With these values we obtained the results given below for No*, iV*u, (~* and w*. Parts (a) and (b) of Figure 5 show the stress resultants in the upper and lower membrane, respectively. The values of h* used are 0.036 and 0.056, representing the upper and lower bounds of the ratios of thickness to radius of curvature. Poisson ratios, v, of 0.1 and 0.5 are used, with 0.1 representing a highly compressible medium and 0.5 an incompressible medium. Values of A are 0.0076 _< ~i < 0.118, the entire range estimated in the preceding section. I t is to be noted t h a t as ~ increases, t h a t is, either EI/E c or (t/R)(h + t/R) getting larger, the stress resultant in the lower membrane tends to have a higher value, while the converse is true for the upper membrane. An increasing E~/E c implies t h a t the membranes are more difficult to stretch; therefore, more force is needed to stretch the lower membrane, and, consequently, less force is transmitted to the upper membrane. The same reasoning can be applied to the case when [(t/R)(h + t)/2R] is large. Most of the increase in ~ however, is due to EI/E c. For all values of 2, we note t h a t N*~ is always greater t h a n No~. The effect of 2 on the transverse normal stress in the mid-plane and the variation of the normal stress across the stroma are shown in parts (a) and (b) of Figure 6, respectively. I t is to be observed t h a t as A increases, o~m decreases; the reason for this is the same as above, t h a t is, the inner membrane is carrying more load, thus less force is being transmitted across the stroma to the outer membrane. The transverse normal stress is shown to decrease linearly across the stroma with the highest value occurring at the inner-membrane side of the stroma. The displacement is shown to be linearly proportional to the intraocular pressure. B u t if equation (23) is expressed in terms of volume changes instead of displacements, it becomes Ap 4 Er
v)

(.~) AV

(25)

3 (1 -

Vo

where lip is the incremental pressure change, and A V is the change of volume. I f we denote K* as a constant t h a t relates change of pressure to change of

450

C.C. MOW 0.50

@
0.25 0.20 0.15 0.10 0.05 0 0

h*=

0.036

v =0.5 Nol -0.1

0.1 Nou 0.5

(a)
I
0.05 X

I
O. 10

I.*= 0 . 0 5 6 No~. "" -~' = 0 . 5 0.1

0.25 0.20 0.15 0. l0 0.05 0

I

-'~''"--~ Nou

0.1
~ ""---"-- -""--'----- 0.5

(b)
I 0.I0 I

0.05

Figure 5 v o l u m e , it is seen t h a t K * is a c t u a l l y d e p e n d e n t u p o n t h e original v o l u m e of t h e e y e . 8 2 This p h e n o m e n o n has b e e n o b s e r v e d a n d r e p o r t e d b y M a m m a r e l l a (1965).

(1

82Here, K* is not the usual ocular rigidity as defined by Freidenwald; rather, K * = Eft / -- ~)RVo.

~IODEL OF THE

CORNEA

451

0.50

/ Crrrm~ --~-o j

-h* ~ -----~

= 0.036

~_o,

--~-"-~. ~ - ~ o ~ oo~.
0.25

Midplane normal stressversusX (a)

f I
lm... y

0.05

O. lO

hc ~

~ Variation of normal stress across cornea (for h :0.056, v:O.5, X:0.0076)

h C

~ ; ~ / - ~ r r~-~ (b)
Gr rm

0.30

0.40
Figure 6

(~)

O.50

0.60

O.70

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C . C . MOW

Equation (23) can also be rearranged into the following form:

For the purpose of comparing the present results with those of Schwartz (1966), we use the experimental value of Ap/Aw = 1/0.004 from that reference, assuming v = 0.1, 0.3 and 0.5, and the values of R and t from the previous seotion. We find that (21.0 x 104 m m H g E r T ~16.4 104 m m H g (11.7 x 104 m m H g O' = 0.1)

(~

= 0.3) (v = 0 . 5 ) .

The values of E~ obtained are very close to the upper-bound value of the Young's modulus estimated b y Schwartz.
VI. Concluding Remarks. This paper has presented a par~ of a study on the mechanics of deformation of the cornea using a sandwich-shell theory. This theory has several advantages such as its ability to take into account the various mechanical properties and dimensions of the layers of the cornea. In addition, it provides results that will yield information on how the stresses are distributed between the membranes and transmitted across the stroma. The limitations on the theory are that it is restricted to small deformation and the materials considered must be linear. Even with these restrictions, we feel that the theory can be applied to applanation tonometry because the displacement in applanation tonometry is small and consequently the linearity assumption for the cornea is perhaps not a bad one. Attempts are being made to reduce the given set of equations (eqs. (1) through (3) and (9) through (13)) to solve the applanationtonometry problem. It is to be noted, however, that in applanation tonometry the problem is the so-called "inverse problem." That is, we are given a displacement while trying to determine the load that caused it. The usual shell problem is to determine the displaeement for a given load. For example, the criterion for the Goldmann applanation tonometer is that it must flatten an area 3.06 mm in diameter. Thus, in effect, we are prescribing displacements over a portion of the cornea. The quantity that we seek in this ease is the load required to flatten this area; we must then determine the relationship of this load to the intraocular pressure. It is apparent from equations (1) through (13) that the load required to flatten a given area veil] depend on the intraoeular pressure, as related through equation (5), and the corneal parameters C*, D* and h. The contribution made by C*, D* and ~ to the applanation load has

MODEL OF THE CORNEA

453

to be s e p a r a t e d f r o m t h e a p p l i e d load before we c a n relate t h e applied l o a d to t h e i n t r a o c u l a r pressure. I n conclusion, we wish to e m p h a s i z e t h a t t h e m o d e l p r e s e n t e d here can o n l y be considered as a n attempt to p r o v i d e a b e t t e r m o d e l for t h e cornea. T h e choice of t h i s m o d e l was b a s e d p r i m a r i l y on s o m e q u a l i t a t i v e f a c t o r s a n d isolated q u a n t i t a t i v e d a t a which are g i v e n in Section 2. T h e v a l i d i t y o f t h e m o d e l will be p r o v e n o n l y w h e n we can a c t u a l l y d e t e r m i n e q u a n t i t a t i v e l y t h e mechanical properties of the Bowman's and Descement's membranes and t h e p r o p e r t i e s of t h e s t r o m a . I t is h o p e d t h a t this p a p e r will s t i m u l a t e some interest a n d will p e r h a p s result in some c o m m e n t s on t h e plausibility o f t h e model.

LITERATURE Draeger, JSrg. 1966. Tonometry: Physical Fundamentals, Development of Methods and Clinical Application. New York: Hafner Publishing Company, Inc. Gloster, J. 1966. Tonometry and Tonography. London: J. & A. Churchill, Ltd. Goldmann, H. 1956. "Applanation Tonometry, Glaucoma," Trans. Second ConJerence F. W. Iqewell (ed.), sponsored by the Josiah Maey Jr. Foundation, New York. Mammarella, E., and M. Malone. 1965. "The Pressure-Volume Relationin Tonometry." Ophthalmologica, 149, 81-89. Maurice, D . M . 1962. The Cornea and Schlera, The Eye, Vol. I, Hugh Davson (ed.). New York and London: Academic Press. Reissner, E. 1946. "Stress and Small Displacement of Shallow Spherical Shells." J. Math. Phys., 25, 80-85. 1949 (March). Small Bending and Stretching of Sandwich-Type Shells, IqACA TN 1832. Schwartz, Nathan J., S. MacKay and J. L. Sackman. 1966. "A Theoretical and Experimental Study of the Mechanical Behaviour of the Cornea With Application to the Measurement of Intraocular Pressure." Bull. Math. Biophysics, 28, 585-643. Wolff, Eugene. 1948. The Anatomy of the Eye and Orbit. Philadelphia and Toronto: The Blakiston Company. RECEIVED 12-18-67