Question 92 of 100

(demo test)

The normal cornea is steepest in the center and flattens toward the edge. Steep means sharply curved, and a sharply curved surface bends light more strongly. So the center of the cornea does most of the focusing work. As you move out toward the limbus, the junction where the clear cornea meets the white sclera, the curve eases off. Another name for this center-steep, edge-flat shape is prolate.

This shape matters because the cornea supplies about two-thirds of the focusing power of the eye. A ball-shaped surface with the same curve everywhere would bend edge rays too strongly. Those rays would miss the focus made by the central rays, an error called spherical aberration. The gentle peripheral flattening trims that error. It also keeps vision steadier as the pupil widens at night and light starts passing through the outer cornea. Refractive surgery makes the same point in reverse. Ablating a small treatment zone can leave glare and halos when the pupil opens wide, so surgeons favor a larger zone. A separate measure, thickness, runs the other way: the cornea is about 0.55 mm thick in the center and about 1.00 mm at its outer edge.

Keep the two ideas apart. Curvature is steep at the center and flat at the edge, while thickness is thin at the center and thick at the edge. Knowing normal corneal shape is a core part of the COA keratometry content area.

Incorrect Answers

• B. This reverses the normal cornea. A center-flat, edge-steep surface is called oblate, and it is a shape surgery or disease leaves behind.
• C. A steep ring around the pupil is not a normal corneal shape. Rings of unusual steepening show up on topography as a sign of disease.
• D. Steep, then flat, then steep again describes an irregular surface. A healthy cornea flattens smoothly all the way out.

Testing Pearls

• The normal cornea is prolate: steepest centrally and flatter toward the limbus.
• The cornea supplies about two-thirds of the eye's focusing power.
• Central thickness is about 0.55 mm; the outer edge is about 1.00 mm.
• Corneal topography maps steeper and flatter zones using rings projected on the tear film.
• A small treatment zone plus a wide pupil is a recipe for night glare and halos.

References

1. American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 2, Anatomy and Physiology of the Eye.
2. American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 10, Adjunctive Tests and Procedures.
3. American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 18, Refractive Surgery Concepts and Procedures.