Modeling The Biomechanical Impact Of Micropore Shape And Distribution On Scleral Flexibility And Dynamic Focusing In Laser Scleral Microporation

This study utilizes Digital Twin (DT) technology and Finite Element Analysis (FEA) to evaluate Laser Scleral Microporation (LSM) as a method for restoring accommodative function in presbyopic eyes. The investigation focuses on removing crosslinked scleral tissue to reduce ocular rigidity, thereby altering the sclera's biomechanical properties to enhance the internal dynamic movement of ocular structures. This approach aims to restore the natural biomechanical flexibility of the eye, improving dynamic focusing ability and enhancing the eye's accommodative response. 

This study was an IRB-registered pilot clinical study, following the Declaration of Helsinki for ethical research. It took place at a specialized ophthalmic center, where patients underwent Laser Scleral Microporation (LSM) therapy to assess its effects on ocular biomechanics and accommodative function. The study involved clinical evaluations and computational modeling to assess LSM’s impact on scleral flexibility, dynamic focusing, and accommodative gain.

An IRB-registered pilot study analyzed 100 eyes from 50 patients treated with LSM therapy. Biometric data were used in a Finite Element Model (FEM) to simulate LSM’s impact on scleral biomechanics, focusing on pore shape, volume, and fiber alignment's effect on stiffness, accommodation, and DCNVA. ANSYS and 3D Digital Twin technology simulated scleral microfibrils in square, diamond, and cylindrical pores (265 μm, 6.2% scleral volume). The study also explored age-related stiffness changes and optimal pore volume for improving accommodation and DCNVA.

The analysis linked predicted DCNVA improvements to scleral stiffness changes post-LSM outcomes. Diamond micropores reduced stiffness most effectively, with optimal 45° orientation maximizing flexibility and dynamic focusing. Younger eyes responded better to LSM. A 30-year-old needed 45% fiber volume for a 6.1% stiffness reduction (11.2% DCNVA X INCREASE), while a 60-year-old required 51% fiber volume for 4.1% reduction (7.4% DCNVA x gain). Interwoven fiber regions improved accommodation more than non-woven areas. Diamond micropores best enhance collagen mobility and accommodation. Finite Element Analysis (FEA) confirmed collagen fiber sliding, highlighting micropore design’s role in optimizing scleral biomechanics and restoring near vision

This study highlights the role of collagen fiber orientation in scleral stiffness and elasticity. LSM-induced changes, particularly pore shape and volume, significantly affect ocular rigidity. Diamond-shaped micropores at 45° were most effective in reducing stiffness and enhancing accommodation and DCNVA gains, with interwoven fibers responding best. Digital Twin (DT) and Finite Element Analysis (FEA) identified optimal micropore parameters for modulating scleral biomechanics and restoring dynamic focusing power. This study provides key insights into micropore design, demonstrating its potential to improve accommodative biomechanics and presbyopia treatment.