Determination Of Biomechanical Changes In The Aging Eye For Development Of Algorithm-Guided Laser Scleral Treatment In Presbyopia
Published 2026 - 44th Congress of the ESCRS
Reference: POREF184 | Type: Free paper | DOI: 10.82333/ghh1-ta58
Authors: Prof. John Marshall* 1 , Dr AnnMarie Hipsley 2 , Dr Edwin Price 3 , Mr Laurent Sabatier 3
1Ophthmology,University College of London,London,United Kingdom;Consultant ,Ace Vision Group ,Boston,United States, 2CEO ,Ace Vision Group ,Boston,United States, 3Employee ,Ace Vision Group ,Boston,United States
Purpose
To characterize age-related ocular biomechanical changes contributing to presbyopia and to determine how scleral architectural modification influences modulus, strain transmission, and central optical power, informing the development of objective treatment algorithms.
Setting
Retrospective computational analysis conducted in a biomedical engineering laboratory using in silico finite element modeling of a virtual age-matched ocular system to simulate scleral architectural interventions.
Methods
Age-associated collagen crosslinking and increased ocular rigidity were modeled within a systems framework incorporating scleral stiffness and reduced Bruch’s Membrane–Choroid Complex (BMCC) recoil of a virtual eye with the biomechanical properties of a 60yo eye in silico. Finite element analysis (FEA) simulated accommodative forces following three scleral architectural modifications in 4 oblique quadrants: (1) macro-incisional expansion (2 parallel 3.5 mm radial ablations), (2) low-density Microporation (9@600um), and (3) high-density micro-architectural Microporation(64@265um). Outcome measures included effective elastic modulus (E), circumferential strain (ε), and simulated central optical power change during accommodative loading.
Results
All interventions had a baseline Central Optical Power (COP) set to 0.27D. Low-density macro-incisional produced a simulated change in COP of 0.03±0.03D. Low-Density macro-architectural Microporation produced a 0.001 ± 0.01D change in COP. High-density micro-architectural Microporation produced a 0.06 ± 0.08 D change in COP. Micro-architectural Microporation proved far more efficient, providing a 12% improvement in COP over 7% macro-insional architecture.
Conclusions
Presbyopia reflects progressive global ocular stiffening with impaired strain transmission and reduced optical power modulation. Micro-architectural scleral remodeling produces greater modulus reduction, enhanced strain coupling, and superior simulated central optical power restoration compared with macro-scale approaches. These findings support development of algorithm-guided laser scleral treatments based on quantified biomechanical parameters to restore Dynamic Range of Focus in presbyopia.