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Corneal biomechanics and endothelial morphology in healthy Saudi adults: a cross-sectional studyThicker corneas in healthy adults drive lower pressure readings

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Key Takeaway
Interpret these normative data cautiously; corneal thickness is the primary driver of biomechanics, with endothelial morphology playing a secondary role in healthy young adults.

This cross-sectional study assessed the relationship between corneal biomechanics and endothelial morphology in 122 healthy Saudi adults aged 18–40 years. The cohort included both hyperopes and myopes, with comparisons by sex and refractive group. No intervention was applied; the study was purely observational.

Main results showed that corneal hysteresis (CH) and corneal resistance factor (CRF) were slightly lower in males compared to females, but these differences were not statistically significant. Goldmann-correlated intraocular pressure (IOPg) was significantly higher in hyperopes versus myopes (p = 0.014). No significant differences were observed in CH, CRF, or corneal-compensated IOP by refractive group.

Central corneal thickness (CCT) correlated moderately with CH (r = 0.40, p < 0.05). Multivariate regression indicated that corneal biomechanics were predominantly driven by CCT, with endothelial morphology exerting a secondary modulatory influence. No adverse events or safety data were reported.

Limitations include the cross-sectional design, which precludes causal inference, and the relatively small sample size. The relationship between these parameters in healthy adults remains understudied. These findings provide foundational normative data relevant for refractive surgery, glaucoma assessment, and regional screening practices, but should be interpreted with caution given the observational nature of the study.

Doctors often measure eye pressure to check for glaucoma. But what if the reading is wrong because of the eye itself? A new look at healthy Saudi adults aged 18 to 40 years helps explain this. The team measured how the cornea bends and how thick it is. They compared people with nearsightedness to those with farsightedness and males to females.

The results showed that males had slightly lower bending strength than females, but this difference was not significant. More importantly, people with farsightedness had higher pressure readings than those with nearsightedness. However, when the team looked at all the factors together, the thickness of the cornea was the main driver of these readings. The shape of the cells on the inner surface of the eye mattered less.

This study is important because it provides baseline data for this specific population. It suggests that doctors must consider cornea thickness when interpreting pressure numbers. Without this context, a healthy person might be misdiagnosed. The findings are based on associations found in this group, not cause-and-effect proof. Still, they offer a clearer picture for screening and surgery planning in the region.

What this means for you:
Cornea thickness is the main factor changing pressure readings in healthy adults.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Corneal biomechanics and endothelial morphology are key to ocular stability, but their relationship in healthy adults remains understudied. In this cross-sectional study, 122 healthy Saudi adults aged 18–40 years were examined using the Ocular Response Analyzer (ORA) to measure corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated intraocular pressure (IOPcc). Corneal endothelial morphology and central corneal thickness (CCT) were assessed using non-contact specular microscopy, providing endothelial cell density, cell count, hexagonality, and morphometric indices. Measurements were obtained under standardized conditions. Associations between biomechanical, endothelial, and refractive variables were evaluated using ANOVA, Pearson correlation analysis, and multivariate regression models. Males showed slightly lower CH, CRF, and endothelial indices, though differences were not significant. IOPg was significantly higher in hyperopes versus myopes (p = 0.014), while no refractive group differences were observed for CH, CRF, or IOPcc. CCT correlated moderately with CH (r = 0.40, p  Corneal biomechanics in healthy adults are predominantly driven by central corneal thickness, with endothelial morphology exerting a secondary modulatory influence on pressure-related and viscoelastic responses. These findings provide foundational normative data with relevance for refractive surgery, glaucoma assessment, and regional screening practices.
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