The cornea is the clear outer layer at the front of the eye. The cornea helps your eye to focus light so you can see clearly.

The eye is remarkable in how it forms images and in the richness of detail and color it can detect. However, our eyes often need some correction to reach what is called “normal” vision. Actually, normal vision should be called “ideal” vision because nearly one-half of the human population requires some sort of eyesight correction, so requiring glasses is by no means “abnormal.” Image formation by our eyes and common vision correction can be analyzed with the optics discussed earlier in this chapter.

Figure 2.29 shows the basic anatomy of the eye. The cornea and lens form a system that, to a good approximation, acts as a single thin lens. For clear vision, a real image must be projected onto the light-sensitive retina, which lies a fixed distance from the lens. The flexible lens of the eye allows it to adjust the radius of curvature of the lens to produce an image on the retina for objects at different distances. The center of the image falls on the fovea, which has the greatest density of light receptors and the greatest acuity (sharpness) in the visual field. The variable opening (i.e., the pupil) of the eye, along with chemical adaptation, allows the eye to detect light intensities from the lowest observable to 10101010 times greater (without damage). This is an incredible range of detection. Processing of visual nerve impulses begins with interconnections in the retina and continues in the brain. The optic nerve conveys the signals received by the eye to the brain.

Figure 2.29 The cornea and lens of the eye act together to form a real image on the light-sensing retina, which has its densest concentration of receptors in the fovea and a blind spot over the optic nerve. The radius of curvature of the lens of an eye is adjustable to form an image on the retina for different object distances. Layers of tissues with varying indices of refraction in the lens are shown here. However, they have been omitted from other pictures for clarity.

The indices of refraction in the eye are crucial to its ability to form images. Table 2.1 lists the indices of refraction relevant to the eye. The biggest change in the index of refraction, which is where the light rays are most bent, occurs at the air-cornea interface rather than at the aqueous humor-lens interface. The ray diagram in Figure 2.30 shows image formation by the cornea and lens of the eye. The cornea, which is itself a converging lens with a focal length of approximately 2.3 cm, provides most of the focusing power of the eye. The lens, which is a converging lens with a focal length of about 6.4 cm, provides the finer focus needed to produce a clear image on the retina. The cornea and lens can be treated as a single thin lens, even though the light rays pass through several layers of material (such as cornea, aqueous humor, several layers in the lens, and vitreous humor), changing direction at each interface. The image formed is much like the one produced by a single convex lens (i.e., a real, inverted image). Although images formed in the eye are inverted, the brain inverts them once more to make them seem upright.

Table 2.1 Refractive Indices Relevant to the Eye *This is an average value. The actual index of refraction varies throughout the lens and is greatest in center of the lens.

Figure 2.30 In the human eye, an image forms on the retina. Rays from the top and bottom of the object are traced to show how a real, inverted image is produced on the retina. The distance to the object is not to scale.

All the different parts of your eyes work together to help you see.

First, light passes through the cornea (the clear front layer of the eye). The cornea is shaped like a dome and bends light to help the eye focus.

Some of this light enters the eye through an opening called the pupil (PYOO-pul). The iris (the colored part of the eye) controls how much light the pupil lets in.

Next, light passes through the lens (a clear inner part of the eye). The lens works together with the cornea to focus light correctly on the retina.

When light hits the retina (a light-sensitive layer of tissue at the back of the eye), special cells called photoreceptors turn the light into electrical signals.

These electrical signals travel from the retina through the optic nerve to the brain. Then the brain turns the signals into the images you see.

Your eyes also need tears to work correctly.

Although the cornea may look clear and seem to lack substance, it is a highly organized tissue. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. Instead, the cornea receives its nourishment from tears and the aqueous humor (a fluid in the front part of the eye that lies behind the cornea).

The tissues of the cornea are arranged in three basic layers, with two thinner layers, or membranes, between them. Each of these five layers has an important function. These layers are:

Epithelium

The epithelium is the cornea’s outermost layer. Its primary functions are to:

1. block the passage into the eye of foreign material, such as dust, water, and bacteria; and
2. provide a smooth surface to absorb oxygen and nutrients from tears, which are then distributed to the other layers of the cornea.

The epithelium is filled with thousands of tiny nerve endings, which is why your eye may hurt when it is rubbed or scratched. The part of the epithelium that epithelial cells anchor and organize themselves to is called the basement membrane.

Bowman’s membrane

The next layer behind the basement membrane of the epithelium is a transparent film of tissue called Bowman’s layer, composed of protein fibers called collagen. If injured, Bowman’s layer can form a scar as it heals. If these scars are large and centrally located, they may cause vision loss.

Stroma

Behind Bowman’s layer is the stroma, which is the thickest layer of the cornea. It is composed primarily of water and collagen. Collagen gives the cornea its strength, elasticity, and form. The unique shape, arrangement, and spacing of collagen proteins are essential in producing the cornea’s light­-conducting transparency.

Descemet's Membrane

Behind the stroma is Descemet’s membrane, a thin but strong film of tissue that serves as a protective barrier against infection and injuries. Descemet’s membrane is composed of collagen fibers that are different from those of the stroma, and are made by cells in the endothelial layer of the cornea (see above). Descemet’s membrane repairs itself easily after injury.

Endothelium

The endothelium is the thin, innermost layer of the cornea. Endothelial cells are important in keeping the cornea clear. Normally, fluid leaks slowly from inside the eye into the stroma. The endothelium’s primary task is to pump this excess fluid out of the stroma. Without this pumping action, the stroma would swell with water and become thick and opaque.

In a healthy eye, a perfect balance is maintained between the fluid moving into the cornea and the fluid pumping out of the cornea. Unlike the cells in Descemet’s membrane, endothelial cells that have been destroyed by disease or trauma are not repaired or replaced by the body.

Every time we blink, tears are distributed across the cornea to keep the eye moist, help wounds heal, and protect against infection. Tears form in three layers:

• An outer, oily (lipid) layer that keeps tears from evaporating too quickly and helps tears remain on the eye?
• A middle (aqueous) layer that nourishes the cornea and the conjunctiva – the mucous membrane that covers the front of the eye and the inside of the eyelids?
• A bottom (mucin) layer that helps spread the aqueous layer across the eye to ensure that the eye remains wet.

The cornea acts as a barrier against dirt, germs, and other particles that can harm the eye. The cornea shares this protective task with the eyelids and eye sockets, tears, and the sclera (white part of the eye). The cornea also plays a key role in vision by helping focus the light that comes into the eye. The cornea is responsible for 65­-75 percent of the eye’s total focusing power.

The cornea and lens of the eye are built to focus light on the retina, which is the light-sensitive tissue at the back of the eye. When light strikes the cornea, it bends—or refracts—the incoming light onto the lens. The lens refocuses that light onto the retina, which starts the translation of light into vision. The retina converts light into electrical impulses that travel through the optic nerve to the brain, which interprets them as images.

The refractive process the eye uses is similar to the way a camera takes a picture. The cornea and lens in the eye act as the camera lens. The retina is like the film (in older cameras), or the image sensor (in digital cameras). If the image is not focused properly, the retina makes a blurry image.

The cornea also serves as a filter that screens out damaging ultraviolet (UV) light from the sun. Without this protection, the lens and the retina would be exposed to injury from UV rays.

Injuries

After minor injuries or scratches, the cornea usually heals on its own. Deeper injuries can cause corneal scarring, resulting in a haze on the cornea that impairs vision. If you have a deep injury, or a corneal disease or disorder, you could experience:

• Pain in the eye
• Sensitivity to light
• Reduced vision or blurry vision
• Redness or inflammation in the eye
• Headache, nausea, fatigue

If you experience any of these symptoms, seek help from an eye care professional.

Allergies

The most common allergies that affect the eye are those related to pollen, particularly when the weather is warm and dry. Symptoms in the eye include redness, itching, tearing, burning, stinging, and watery discharge, although usually not severe enough to require medical attention. Antihistamine decongestant eyedrops effectively reduce these symptoms. Rain and cooler weather, which decreases the amount of pollen in the air, can also provide relief.

Keratitis

Keratitis is an inflammation of the cornea. Noninfectious keratitis can be caused by a minor injury, or from wearing contact lenses too long. Infection is the most common cause of keratitis. Infectious keratitis can be caused by bacteria, viruses, fungi or parasites. Often, these infections are also related to contact lens wear, especially improper cleaning of contact lenses or overuse of old contact lenses that should be discarded. Minor corneal infections are usually treated with antibacterial eye drops. If the problem is severe, it may require more intensive antibiotic or antifungal treatment to eliminate the infection, as well as steroid eye drops to reduce inflammation.

Dry eye

Dry eye is a condition in which the eye produces fewer or lower quality tears and is unable to keep its surface lubricated.

The main symptom of dry eye is usually a scratchy feeling or as if something is in your eye. Other symptoms include stinging or burning in the eye, episodes of excess tearing that follow periods of dryness, discharge from the eye, and pain and redness in the eye.

Sometimes people with dry eye also feel as if their eyelids are very heavy or their vision is blurred. For more detailed information about dry eye and its treatments.

The need for some type of vision correction is very common. Common vision defects are easy to understand, and some are simple to correct. Figure 26.5 illustrates two common vision defects. Nearsightedness, or myopia, is the inability to see distant objects clearly while close objects are clear. The eye overconverges the nearly parallel rays from a distant object, and the rays cross in front of the retina. More divergent rays from a close object are converged on the retina for a clear image. The distance to the farthest object that can be seen clearly is called the far point of the eye (normally infinity). Farsightedness, or hyperopia, is the inability to see close objects clearly while distant objects may be clear. A farsighted eye does not converge sufficient rays from a close object to make the rays meet on the retina. Less diverging rays from a distant object can be converged for a clear image. The distance to the closest object that can be seen clearly is called the near point of the eye (normally 25 cm).

Figure 26.5 (a) The nearsighted (myopic) eye converges rays from a distant object in front of the retina; thus, they are diverging when they strike the retina, producing a blurry image. This can be caused by the lens of the eye being too powerful or the length of the eye being too great. (b) The farsighted (hyperopic) eye is unable to converge the rays from a close object by the time they strike the retina, producing blurry close vision. This can be caused by insufficient power in the lens or by the eye being too short.

Since the nearsighted eye over converges light rays, the correction for nearsightedness is to place a diverging spectacle lens in front of the eye. This reduces the power of an eye that is too powerful. Another way of thinking about this is that a diverging spectacle lens produces a case 3 image, which is closer to the eye than the object (see Figure 26.6). To determine the spectacle power needed for correction, you must know the person’s far point—that is, you must know the greatest distance at which the person can see clearly. Then the image produced by a spectacle lens must be at this distance or closer for the nearsighted person to be able to see it clearly. It is worth noting that wearing glasses does not change the eye in any way. The eyeglass lens is simply used to create an image of the object at a distance where the nearsighted person can see it clearly. Whereas someone not wearing glasses can see clearly objects that fall between their near point and their far point, someone wearing glasses can see images that fall between their near point and their far point.

Figure 26.6 Correction of nearsightedness requires a diverging lens that compensates for the overconvergence by the eye. The diverging lens produces an image closer to the eye than the object, so that the nearsighted person can see it clearly.

Since the farsighted eye under converges light rays, the correction for farsightedness is to place a converging spectacle lens in front of the eye. This increases the power of an eye that is too weak. Another way of thinking about this is that a converging spectacle lens produces a case 2 image, which is farther from the eye than the object (see Figure 26.7). To determine the spectacle power needed for correction, you must know the person’s near point—that is, you must know the smallest distance at which the person can see clearly. Then the image produced by a spectacle lens must be at this distance or farther for the farsighted person to be able to see it clearly.

Figure 26.7 Correction of farsightedness uses a converging lens that compensates for the under convergence by the eye. The converging lens produces an image farther from the eye than the object, so that the farsighted person can see it clearly.

Another common vision defect is astigmatism, an unevenness or asymmetry in the focus of the eye. For example, rays passing through a vertical region of the eye may focus closer than rays passing through a horizontal region, resulting in the image appearing elongated. This is mostly due to irregularities in the shape of the cornea but can also be due to lens irregularities or unevenness in the retina. Because of these irregularities, different parts of the lens system produce images at different locations. The eye-brain system can compensate for some of these irregularities, but they generally manifest themselves as less distinct vision or sharper images along certain axes. Figure 26.8 shows a chart used to detect astigmatism. Astigmatism can be at least partially corrected with a spectacle having the opposite irregularity of the eye. If an eyeglass prescription has a cylindrical correction, it is there to correct astigmatism. The normal corrections for short- or farsightedness are spherical corrections, uniform along all axes.

Figure 26.8 This chart can detect astigmatism, unevenness in the focus of the eye. Check each of your eyes separately by looking at the center cross (without spectacles if you wear them). If lines along some axes appear darker or clearer than others, you have an astigmatism.

Contact lenses have advantages over glasses beyond their cosmetic aspects. One problem with glasses is that as the eye moves, it is not at a fixed distance from the spectacle lens. Contacts rest on and move with the eye, eliminating this problem. Because contacts cover a significant portion of the cornea, they provide superior peripheral vision compared with eyeglasses. Contacts also correct some corneal astigmatism caused by surface irregularities. The tear layer between the smooth contact and the cornea fills in the irregularities. Since the index of refraction of the tear layer and the cornea are very similar, you now have a regular optical surface in place of an irregular one. If the curvature of a contact lens is not the same as the cornea (as may be necessary with some individuals to obtain a comfortable fit), the tear layer between the contact and cornea acts as a lens. If the tear layer is thinner in the center than at the edges, it has a negative power, for example. Skilled optometrists will adjust the power of the contact to compensate.

Other advances in vision correction demonstrate the interconnectedness and value of scientific research. In the 1980s, Donna Strickland and Gérard Mourou worked on ways to make small but powerful lasers. Up until that time, powerful lasers had to be quite large in order to function properly. Essentially, the intensity of the beam itself would modify the instrument’s ability to function and create too much heat to be practical. Strickland and Mourou used ultrashort laser pulses passed over a grating that modified the beam but retained its power. Chirped pulse amplification, as it became known, has been used to develop most of the highest-powered lasers in the world, but also some of the smallest and most common. Decades after their initial discovery, Strickland and Mourou were awarded the Nobel Prize for Physics (with Strickland becoming the third woman to receive the award) partly due to CPA’s pivotal role in the increasingly common practice of laser vision correction—an application neither planned during their initial research.

Laser vision correction has progressed rapidly in the last few years. It is the latest and by far the most successful in a series of procedures that correct vision by reshaping the cornea. As noted at the beginning of this section, the cornea accounts for about two-thirds of the power of the eye. Thus, small adjustments of its curvature have the same effect as putting a lens in front of the eye. To a reasonable approximation, the power of multiple lenses placed close together equals the sum of their powers. For example, a concave spectacle lens (for nearsightedness) having 𝑃=−3.00 D�=−3.00 D has the same effect on vision as reducing the power of the eye itself by 3.00 D. So to correct the eye for nearsightedness, the cornea is flattened to reduce its power. Similarly, to correct for farsightedness, the curvature of the cornea is enhanced to increase the power of the eye—the same effect as the positive power spectacle lens used for farsightedness. Laser vision correction uses high intensity electromagnetic radiation to ablate (to remove material from the surface) and reshape the corneal surfaces.

Today, the most commonly used laser vision correction procedure is Laser in situ Keratomileusis (LASIK). The top layer of the cornea is surgically peeled back and the underlying tissue ablated by multiple bursts of finely controlled ultraviolet radiation produced by an excimer laser. Lasers are used because they not only produce well-focused intense light, but they also emit very pure wavelength electromagnetic radiation that can be controlled more accurately than mixed wavelength light. The 193 nm wavelength UV commonly used is extremely and strongly absorbed by corneal tissue, allowing precise evaporation of very thin layers. A computer controlled program applies more bursts, usually at a rate of 10 per second, to the areas that require deeper removal. Typically a spot less than 1 mm in diameter and about 0.3μm0.3μm in thickness is removed by each burst. Nearsightedness, farsightedness, and astigmatism can be corrected with an accuracy that produces normal distant vision in more than 90% of the patients, in many cases right away. The corneal flap is replaced; healing takes place rapidly and is nearly painless. More than 1 million Americans per year undergo LASIK (see Figure 26.9).

The cornea copes very well with minor injuries or abrasions. If the highly sensitive cornea is scratched, healthy cells slide over quickly and patch the injury before infection occurs and vision is affected. If the scratch penetrates the cornea more deeply, however, the healing process will take longer, at times resulting in greater pain, blurred vision, tearing, redness, and extreme sensitivity to light. These symptoms require professional treatment. Deeper scratches can also cause corneal scarring, resulting in a haze on the cornea that can greatly impair vision. In this case, a corneal transplant may be needed.