Corneal structure, transparency, thickness and optical density (densitometry), especially as relevant to contact lens wear—a review

Clinical instruments using Scheimpflug image-based methods to obtain optical sectional images of the cornea have been introduced in recent years along with proposals that it should be possible to routinely and reliably measure the optical density (referred to as the densitometry) of the human cornea in situ. Such a concept is reviewed from the perspective of what might be considered as the basic principles underlying the understanding of corneal transparency (from the 1950's) and the progressive changes in these ideas from subjective slitlamp-based clinical observations from the late 1960's, especially in contact lens wearers. Much more has been learned about the overall macrostructure (including corneal thickness) and the ultrastructure of the cornea from contemporary studies in the 1990's, and these aspects of the cornea will be reviewed alongside consideration of the methods of assessing the optical characteristics of the cornea in the living eye. From these perspectives, in this review systematic consideration will be given to what objective (quantitative) output one of these Scheimpflug-based systems provides and how this information might be actually related to corneal transparency characteristics that might be observed clinically, particularly after long-term contact lens wear.