II. THE EFFECT OF INTRA-OCULAR PRESSURE

BY A. STANWORTH

*Department of Ophthalmology, University of Manchester*

*{Received 14 May 1952)*

A. THE MEASUREMENT OF THE RETARDATION OF THE CORNEA Preliminary experiments on the change of corneal retardation with changes in intra-ocular pressure have been described elsewhere (Stanworth, 1949, 1950). Theoretical considerations, together with measurements of the retardation of the cornea at different pressures with transmitted light passing in various directions, led to the conclusion that in order to obtain the maximum change in retardation,

Fig. 2. Light path reflected from posterior corneal surface.

*Polarized light studies of the cornea 165*

*(1) The retardation for obliquely reflected light*

*Let the incident plane polarized light be represented by u^ = A cos cot in the plane*
*of incidence, and vx=B cos tut perpendicular to the plane of incidence.*

Then using Fresnel's formulae, the light emerging after refraction, reflexion and a second refraction, for a system symmetrical about the point of reflexion (P) on the posterior surface, is given by

*A sin 2/ sin zR tan (I± —*
2_{ (/+/?) cos* ( / - / ? ) tan (4}
*— B sin 2/ sin zR sin(/,— R,)*

*_ A sin 2/ sin zR tan (I±* i?a)

"2 = sin2 (/+/?) cos* ( / - / ? ) tan ( 4 + ^ ) C°*S wt'*

*V*

*>= sin> (I+R) sin (*

*where <f> is the retardation produced by the cornea of the vertical component *
*com-pared with the horizontal component. / and R are angles of incidence and *
refrac-tion for incident light at anterior surface. /x* and R±* are angles of incidence and

refraction at posterior surface. This is the form of the general expression for an elliptical vibration; that is,

*u = M cos cot, )*

*v = Ncos (cot-<f>).\*

*The sign of NjM depends on the relative signs of A and B and the sign of*
tan ' ( / I + ^ I )

-From the known curvature and thickness of the cornea the length of the light
*path and the values of Ix and R can be calculated for any angle of incidence, the*

average of the latter being the average angle between the light pathway and the optic axis of the cornea. If then the constants of the elliptically polarized emergent light can be measured, the birefringence of the cornea can be calculated.

*(2) Methods of measurement of the ellipticity of the emergent light*

The most accurate methods of measurement of elliptically polarized light involve the use of some kind of half-shade device; in the present instance, however, the observed field is not uniform, and such devices cannot be used. In addition, the positions of the principal axes of the light vary with the retardation and have to be determined for each measurement. The possible methods that can be used are, therefore, both less accurate and less facile than those in general use. The method adopted was to place a quarter-wave plate with its fast axis along the major axis of the emergent ellipse, thus converting the .light to plane-polarized light, the azimuth of which was then measured. The ellipticity (e) of the light is then given by the clockwise angle between the major axis, and this azimuth.

*The retardation of the cornea (<f>) is then given by*

*, tan 7.e , .*

## ^ - s n s -

### (2)

*The sign of cos <fi is obtained from the formula*
*tan 20*
C O S 0 = **r ,**

*tan 21*

*where tan i=MjN. The value of <£ + 27m is thus determined.*
The disadvantages of the foregoing method are:

*(i) In equation (2), used for determining the numerical value of </>, a given change*
*in <f> will lead to only a small change in e when 6 is small. The maximum sensitivity*
*will be when sin 28= + 1, i.e. 6 = \n or £TT.*

(ii) A change in the retardation will, in general, lead to a change in the position of the major axis of the ellipse. The whole procedure for the measurement of the ellipticity should therefore be repeated. Since, however, in the present case, the change in the retardation is relatively small, it was usually sufficient to assume that the position of the axes remained constant, and to take the change in analyser position as a measure of the change in ellipticity. It would obviously be an advan-tage, however, if the position of the axes remained constant with a change in retardation.

*This can be done, and maximum sensitivity obtained, for, if M= ± N, tan i= ± 1*
*and tan 2t= ±00. So, from equation (3), tan 26= ±00 for all values of (f>, i.e.*

*6 = ± \TT for all values of <f>. And, from equation (2) tan <f> = + tan 2e, i.e.*

*<j> = ± t a n 2e + \mr.*

This arrangement is that used by Goranson & Adams (1933). In view of these
considerations, the plane of polarization of the light entering the cornea was always
*arranged empirically so as to give a value of 9 as near as possible to + 45°.*

In practice the desired setting can most easily be obtained by placing the analyser in the diagonal position and rotating the polarizer to give the minimum intensity of the posterior specular reflex. For in these circumstances,

*/ = \ + \ sin 21 cos <f>,*

*which has its minimum value when 1 = 45° or 135°, depending on the sign of cos <f>.*
Since, as described above, a half-shade device cannot be used, the determination
of the azimuth of the axes of the ellipse may not always be accurate. To avoid an
error from this cause, the quarter-wave plate can be rotated from one side to the
other of the estimated position, the least numerical value for the rotation of the
analyser—from the position parallel to the axis of the quarter-wave plate to the new
minimum position after the insertion of the quarter-wave plate—being a direct
measure of the ellipticity of the incident light. That this is the case can be shown
as follows:

*Let elliptically polarized light with principal axes a and b fall on a quarter-wave*
plate with its fast axis at an angle « to the major axis of the ellipse, and then on an
*analyser at an angle e' to the fast axis of the plate.*

Then the intensity / of light passed by the analyser is given by

*Polarized light studies of the cornea 167*

*T)ifferentiating / with respect to e' for a constant value of a, we find that, for the*
*maximum value of I,*

*where e" indicates the analyser position for maximum intensity, and e" is between o*
*and — \n if bja is positive, e" is between o and \n if bja is negative. From equation (4)*
*differentiating e" with respect to a we find that e" has a maximum or minimum*
*value when either b = a (the condition for circulary polarized light) or e" = o or \n*
*(which can only be true if the incident light is plane polarized) or a = o or \TT (which*
*applies to any incident light). In the latter case it can easily be shown that if n is an*
even integer (i.e. the quarter-wave plate has its fast axis along the major axis of the
*ellipse) e" is at its maximum value if bja is positive.*

*But it was shown above that e" is then between o and — \n, so e is the minimum*
*numerical value of e" in a clockwise direction. Similarly if bja is negative, e is the*
*minimum numerical value of e" in an anti-clockwise direction.*

*These relationships are reversed if n is an odd integer, the quarter wave plate*
having its slow axis along the major axis of the original ellipse.

*Results*

The Fresnel formulae used are only approximate, so it was considered necessary to verify the method experimentally. A piece of adhesive cellophane tape was fixed on a glass slide, and its retardation measured for normal incidence by transmitted light. The slide was then rotated, first about an axis containing the optic axis of the cellophane tape, and then about an axis at right angles to this, the retardation being measured for varying angles of incidence. The retardation was then measured by light reflected from the back surface of the glass slide; the maximum error was nowhere greater than 6 %. The experimental results with the cat cornea also showed that the method is reasonably accurate; the retardation of the cornea in a pressure chamber (Stanworth & Naylor, 1950) was measured under constant con-ditions but with different positions of the polarizer. The calculated retardation varied by only + 10 m/x from the arithmetical mean.

The preliminary results (Stanworth, 1950) obtained by reflected light from a cornea suspended in a pressure chamber correspond to a birefringence of the corneal fibres of 0-0037 (for light of wave-length 540 m/x), almost all the results falling between 0-0030 and 0-0045. The change in birefringence when the pressure behind the cornea was raised from 10 to 40 mm. Hg averaged 0-00012, i.e. about 3% of the total. The rate of increase in birefringence decreased at higher pressures, but this had little if any effect below a pressure of about 30 mm. Hg, i.e. over the physiological range.

The experiments were repeated with the whole eye suspended by sutures through the episclera, the pressure being varied through a needle inserted through the optic nerve and past the dislocated lens. In this case the change in birefringence for the above change in pressure was about 7 % of the total. It appears, then, that

by far the greater part of the double refraction of the cornea is determined by the structure of the corneal fibre and only a relatively small proportion is due to stress.

B. THE MEASUREMENT OF CHANGES IN RETARDATION BY PHOTOGRAPHY

Measurement of retardation by density of a photographic image can be very sensitive (Swann & Mitchison, 1950), and was used in the present case in an attempt to make the method sufficiently easy to envisage its application to the human subject.

*For the light leaving the cornea, the intensity I passed by an analyser at angle 7 to*
the horizontal is

*I=M2* cos2* y and N2* sin2* y + MN sin zy cos 0.*

To obtain the greatest rate of change of intensity with changes in retardation,

*MN and sin 2y should have their maximum values, i.e. M=N, and 7 = 45° or 135°;*

in these circumstances, 7=sin2§<£, and the polarizer is set as before.

In practice it was not convenient to set the polarizer in this manner, since the
anterior specular reflex was not then at minimum intensity and tended to overlap
the posterior reflex. The polarizer was set to give minimum intensity of the anterior
*reflex. Under these circumstances I=\± MN cos <f>, and the rate of change of*
intensity is not at its maximum value.

Whatever the polarizer setting, the maximum change in intensity for a given
*change in <f> will occur when <f> = \TT ± rnr. If the phase difference is between o and*

1800, the intensity should increase, but if it is between 180 and 3600, it should decrease, with rising pressure. If it is slightly less than 1800, the slight initial increase in intensity will not produce any appreciable increase in density, and only the subsequent fall will be seen. If the initial phase difference is slightly lower still, a preliminary rise will be followed by a fall. The reverse will occur with an initial phase difference slightly less than 3600.

These predictions were confirmed by measurement, by an S.E.I, densitometer, of
500 photographs taken at different pressures, using the cornea suspended as before
*and fast orthochromatic film (Kodak Ortho. X), at \ sec. exposures, in a specially*
constructed fixed focus miniature camera giving a magnification of x f. Corneae
with phase differences from 340 to 3600 and o to 1600 showed an average increase
in image density, with increasing pressure, of 0-13; those with a phase difference
180-3300 showed an average fall in density of 0-15. Corneae with phase differences
of 168, 100 and 3300 showed a biphasic response.

*Polarized light studies of the cornea 169*

SUMMARY

A method is described of measuring the birefringence of the intact cornea using light reflected obliquely from its posterior surface. The value obtained (0-0037) is in reasonable agreement with the results obtained by using transmitted light and from corneal sections. The change in birefringence with an increase in intraocular pressure from 10 to 40 mm. Hg is about 7 % of this. The change in birefringence was also assessed by changes in the density of the photographic image of the reflected light from the surface, and this affords a possible way in which the intra-ocular pressure could be measured in the human subject without touching the eye.

REFERENCES

GORANSON, R. W. & ADAMS, L. H. (1933). A method for the precise measurement of optical
**path-difference, especially in stressed glass. J. Franklin Inst. 216, 475-504.**

*STANWORTH, A. (1949). The cornea in polarized light. (Preliminary communication). Brit. J.*
*Ophthal. 33, 485-490.*

STANWORTH, A. (1950). Effect of intraocular pressure on the polarization optics of the cornea.
*Acta XVI. Concilium Ophthalmologicum (Britannia), 2, 1368—76.*

*STANWORTH, A. & NAYLOR, E. J. (1950). The polarization optics of the isolated cornea. Brit. jf.*
*Ophthal. 34, 201-11.*