Biofluid modeling of the coupled eye-brain system and insights into simulated microgravity conditions.

This work aims at investigating the interactions between the flow of fluids in the eyes and the brain and their potential implications in structural and functional changes in the eyes of astronauts, a condition also known as spaceflight associated neuro-ocular syndrome (SANS). To this end, we propose a reduced (0-dimensional) mathematical model of fluid flow in the eyes and brain, which is embedded into a simplified whole-body circulation model. In particular, the model accounts for: (i) the flows of blood and aqueous humor in the eyes; (ii) the flows of blood, cerebrospinal fluid and interstitial fluid in the brain; and (iii) their interactions. The model is used to simulate variations in intraocular pressure, intracranial pressure and blood flow due to microgravity conditions, which are thought to be critical factors in SANS. Specifically, the model predicts that both intracranial and intraocular pressures increase in microgravity, even though their respective trends may be different. In such conditions, ocular blood flow is predicted to decrease in the choroid and ciliary body circulations, whereas retinal circulation is found to be less susceptible to microgravity-induced alterations, owing to a purely mechanical component in perfusion control associated with the venous segments. These findings indicate that the particular anatomical architecture of venous drainage in the retina may be one of the reasons why most of the SANS alterations are not observed in the retina but, rather, in other vascular beds, particularly the choroid. Thus, clinical assessment of ocular venous function may be considered as a determinant SANS factor, for which astronauts could be screened on earth and in-flight.

A Mathematical Model of Corneal Metabolism in the Presence of an Iris-Fixated Phakic Intraocular Lens.

Purpose: Corneal endothelial cell loss is one of the possible complications associated with phakic iris-fixated intraocular lens (PIOL) implantation. We postulate that this might be connected to the alteration of corneal metabolism secondary to the lens implantation. Methods: A mathematical model of transport and consumption/production of metabolic species in the cornea is proposed, coupled with a model of aqueous flow and transport of metabolic species in the anterior chamber. Results: Results are presented both for open and closed eyelids. We showed that, in the presence of a PIOL, glucose availability at the corneal endothelium decreases significantly during sleeping. Conclusions: Implantation of a PIOL significantly affects nutrient transport processes to the corneal endothelium especially during sleep. It must still be verified whether this finding has a clinical relevance.

A structural model for the in vivo human cornea including collagen-swelling interaction.

A structural model of the in vivo cornea, which accounts for tissue swelling behaviour, for the three-dimensional organization of stromal fibres and for collagen-swelling interaction, is proposed. Modelled as a binary electrolyte gel in thermodynamic equilibrium, the stromal electrostatic free energy is based on the mean-field approximation. To account for active endothelial ionic transport in the in vivo cornea, which modulates osmotic pressure and hydration, stromal mobile ions are shown to satisfy a modified Boltzmann distribution. The elasticity of the stromal collagen network is modelled based on three-dimensional collagen orientation probability distributions for every point in the stroma obtained by synthesizing X-ray diffraction data for azimuthal angle distributions and second harmonic-generated image processing for inclination angle distributions. The model is implemented in a finite-element framework and employed to predict free and confined swelling of stroma in an ionic bath. For the in vivo cornea, the model is used to predict corneal swelling due to increasing intraocular pressure (IOP) and is adapted to model swelling in Fuchs' corneal dystrophy. The biomechanical response of the in vivo cornea to a typical LASIK surgery for myopia is analysed, including tissue fluid pressure and swelling responses. The model provides a new interpretation of the corneal active hydration control (pump-leak) mechanism based on osmotic pressure modulation. The results also illustrate the structural necessity of fibre inclination in stabilizing the corneal refractive surface with respect to changes in tissue hydration and IOP.

The Balance of Fluid and Osmotic Pressures across Active Biological Membranes with Application to the Corneal Endothelium.

The movement of fluid and solutes across biological membranes facilitates the transport of nutrients for living organisms and maintains the fluid and osmotic pressures in biological systems. Understanding the pressure balances across membranes is crucial for studying fluid and electrolyte homeostasis in living systems, and is an area of active research. In this study, a set of enhanced Kedem-Katchalsky (KK) equations is proposed to describe fluxes of water and solutes across biological membranes, and is applied to analyze the relationship between fluid and osmotic pressures, accounting for active transport mechanisms that propel substances against their concentration gradients and for fixed charges that alter ionic distributions in separated environments. The equilibrium analysis demonstrates that the proposed theory recovers the Donnan osmotic pressure and can predict the correct fluid pressure difference across membranes, a result which cannot be achieved by existing KK theories due to the neglect of fixed charges. The steady-state analysis on active membranes suggests a new pressure mechanism which balances the fluid pressure together with the osmotic pressure. The source of this pressure arises from active ionic fluxes and from interactions between solvent and solutes in membrane transport. We apply the proposed theory to study the transendothelial fluid pressure in the in vivo cornea, which is a crucial factor maintaining the hydration and transparency of the tissue. The results show the importance of the proposed pressure mechanism in mediating stromal fluid pressure and provide a new interpretation of the pressure modulation mechanism in the in vivo cornea.

Three-dimensional modeling of metabolic species transport in the cornea with a hydrogel intrastromal inlay.

PURPOSE: Intrastromal inlays for refractive correction of presbyopia are being adopted into clinical practice. An important concern is the effect of the inlay on the long-term health of the cornea due to disturbances in the concentration profiles of metabolic species. A three-dimensional metabolic model for the cornea is employed to investigate oxygen, glucose, and lactate ion transport in the cornea and to estimate changes in species concentrations induced by the introduction of a hydrogel inlay. METHODS: A reaction-diffusion metabolic model, appropriate for highly oxygen-permeable hydrogel inlays, is used to describe cellular consumption of oxygen and glucose and production of lactic acid. A three-layer corneal geometry (epithelium, stroma, endothelium) is employed with a hydrogel inlay placed under a lamellar flap. The model is solved numerically by the finite element method. RESULTS: For a commercially available hydrogel material with a relative inlay diffusivity of 43.5%, maximum glucose depletion and lactate ion accumulation occur anterior to the inlay and both are less than 3%. Below 20% relative diffusivity, glucose depletion and lactate ion accumulation increase exponentially. Glucose depletion increases slightly with increasing depth of inlay placement. CONCLUSIONS: The flux of metabolic species is modified by an inlay, depending on the inlay relative diffusivity. For commercially available hydrogel materials and a typical inlay design, predicted changes in species concentrations are small when compared to the variation of concentrations across the normal cornea. In general, glucose depletion and lactate ion accumulation are highly sensitive to inlay diffusivity and somewhat insensitive to inlay depth.

THREE-DIMENSIONAL MODELING OF METABOLIC SPECIES TRANSPORT IN THE CORNEA WITH A HYDROGEL INTRASTROMAL INLAY.

Purpose: Intrastromal inlays for refractive correction of presbyopia are being adopted into clinical practice. An important concern is the effect of the inlay on the long-term health of the cornea due to disturbances in the concentration profiles of metabolic species. A 3-D metabolic model for the cornea is employed to investigate oxygen, glucose and lactate ion transport in the cornea and to estimate changes in species concentrations induced by the introduction of a hydrogel inlay. Methods: A reaction-diffusion metabolic model, appropriate for highly oxygen-permeable hydrogel inlays, is used to describe cellular consumption of oxygen and glucose and production of lactic acid. A three-layer corneal geometry (epithelium, stroma, endothelium) is employed with a hydrogel inlay placed under a lamellar flap. The model is solved numerically by the finite element method. Results: For a commercially available hydrogel material with a relative inlay diffusivity of 43.5%, maximum glucose depletion and lactate ion accumulation occur anterior to the inlay and both are less than 3%. Below 20% relative diffusivity, glucose depletion and lactate ion accumulation increase exponentially. Glucose depletion increases slightly with increasing depth of inlay placement. Conclusions: The flux of metabolic species is modified by an inlay, depending on the inlay relative diffusivity. For commercially available hydrogel materials and a typical inlay design, predicted changes in species concentrations are small when compared to the variation of concentrations across the normal cornea. In general, glucose depletion and lactate ion accumulation are highly sensitive to inlay diffusivity and somewhat insensitive to inlay depth.

Three-dimensional distribution of transverse collagen fibers in the anterior human corneal stroma.

PURPOSE: Recent investigations of human corneal structure and biomechanics have shown that stromal collagen fibers (lamellae) are organized into a complex, highly intertwined three-dimensional meshwork of transverse oriented fibers that increases stromal stiffness and controls corneal shape. The purpose of this study was to characterize the three-dimensional distribution of transverse collagen fibers along the major meridians of the cornea using an automated method to rapidly quantify the collagen fibers' angular orientation. METHODS: Three eyes from three donors were perfusion-fixed under pressure, excised, and cut into four quadrants. Quadrants were physically sectioned using a vibratome and scanned using nonlinear optical high-resolution macroscopy. Planes were analyzed numerically using software to identify collagen fiber angles relative to the corneal surface, stromal depth, and radial position within the anterior 250 µm of the stroma. RESULTS: The range of fiber angles and the fiber percentage having an angular displacement greater than ±3.5° relative to the corneal surface ("transverse fibers") was highest in the anterior stroma and decreased with depth. Numerical analysis showed no significant differences in fiber angles and transverse fibers between quadrants, meridians, and radial position. CONCLUSIONS: These results match our previous observation of a depth-dependent gradient in stromal collagen interconnectivity in the central cornea, and show that this gradient extends from the central cornea to the limbus. The lack of a preferred distribution of angled fibers with regard to corneal quadrant or radial position likely serves to evenly distribute loads and to avoid the formation of areas of stress concentration.

Mechanisms of self-organization for the collagen fibril lattice in the human cornea.

The transparency of the human cornea depends on the regular lattice arrangement of the collagen fibrils and on the maintenance of an optimal hydration--the achievement of both depends on the presence of stromal proteoglycans (PGs) and their linear sidechains of negatively charged glycosaminoglycans (GAGs). Although the GAGs produce osmotic pressure by the Donnan effect, the means by which they exert positional control of the lattice is less clear. In this study, a theoretical model based on equilibrium thermodynamics is used to describe restoring force mechanisms that may control and maintain the fibril lattice and underlie corneal transparency. Electrostatic-based restoring forces that result from local charge density changes induced by fibril motion, and entropic elastic restoring forces that arise from duplexed GAG structures that bridge neighbouring fibrils, are described. The model allows for the possibility that fibrils have a GAG-dense coating that adds an additional fibril force mechanism preventing fibril aggregation. Swelling pressure predictions are used to validate the model with results showing excellent agreement with experimental data over a range of hydration from 30 to 200% of normal. The model suggests that the electrostatic restoring force is dominant, with the entropic forces from GAG duplexes being an order or more smaller. The effect of a random GAG organization, as observed in recent imaging, is considered in a dynamic model of the lattice that incorporates randomness in both the spatial distribution of GAG charge and the topology of the GAG duplexes. A striking result is that the electrostatic restoring forces alone are able to reproduce the image-based lattice distribution function for the human cornea, and thus dynamically maintain the short-range order of the lattice.

The role of 3-D collagen organization in stromal elasticity: a model based on X-ray diffraction data and second harmonic-generated images.

Examining the cross-section of the human cornea with second harmonic-generated (SHG) imaging shows that many lamellae do not lie parallel to the cornea's anterior surface but have inclined trajectories that take them through the corneal thickness with a depth-dependent distribution. A continuum mechanics-based model of stromal elasticity is developed based on orientation information extracted and synthesized from both X-ray scattering studies and SHG imaging. The model describes the effects of inclined lamella orientation by introducing a probability function that varies with depth through the stroma, which characterizes the range and distribution of lamellae at inclined angles. When combined with the preferred lamellar orientations found from X-ray scattering experiments, a fully 3-D representation of lamella orientation is achieved. Stromal elasticity is calculated by a weighted average of individual lamella properties based on the spatially varying 3-D orientation distribution. The model is calibrated with in vitro torsional shear experiments and in vivo indentation data and then validated with an in vitro inflation study. A quantitative explanation of the experimentally measured depth dependence of mechanical properties emerges from the model. The significance of the 3-D lamella orientation in the mechanics of the human cornea is demonstrated by investigating and contrasting the effects of previous modeling assumptions made on lamella orientation.

Depth-dependent transverse shear properties of the human corneal stroma.

PURPOSE: To measure the transverse shear modulus of the human corneal stroma and its profile through the depth by mechanical testing, and to assess the validity of the hypothesis that the shear modulus will be greater in the anterior third due to increased interweaving of lamellae. METHODS: Torsional rheometry was used to measure the transverse shear properties of 6 mm diameter buttons of matched human cadaver cornea pairs. One cornea from each pair was cut into thirds through the thickness with a femtosecond laser and each stromal third was tested individually. The remaining intact corneas were tested to measure full stroma shear modulus. The shear modulus from a 1% shear strain oscillatory test was measured at various levels of axial compression for all samples. RESULTS: After controlling for axial compression, the transverse shear moduli of isolated anterior layers were significantly higher than central and posterior layers. Mean modulus values at 0% axial strain were 7.71 ± 6.34 kPa in the anterior, 1.99 ± 0.45 kPa in the center, 1.31 ± 1.01 kPa in the posterior, and 9.48 ± 2.92 kPa for full thickness samples. A mean equilibrium compressive modulus of 38.7 ± 8.6 kPa at 0% axial strain was calculated from axial compression measured during the shear tests. CONCLUSIONS: Transverse shear moduli are two to three orders of magnitude lower than tensile moduli reported in the literature. The profile of shear moduli through the depth displayed a significant increase from posterior to anterior. This gradient supports the hypothesis and corresponds to the gradient of interwoven lamellae seen in imaging of stromal cross-sections.