Global spatiotemporal biomechanics using video swin transformer: multiscale validation and clinical impact for keratoconus suspects

Biomechanical assessment offers a novel approach for the diagnosis and treatment of corneal ectatic disorders, particularly keratoconus, a blinding eye disease characterized by biomechanical weakening. However, current early diagnosis primarily relies on morphology, such as corneal tomography, which can lead to missed cases. This study utilized a video swin transformer to characterize global spatiotemporal corneal biomechanics from deformation videos. This model captures the entire dynamic process, significantly enhancing the diagnostic accuracy for suspicious cases (AUC 0.9942; accuracy 97.37%; 95% CI: 93.0%, 99.7%). Temporal-importance analysis revealed rebound-phase energy dissipation as a key early marker. Additionally, atomic force microscopy-based nanoindentation and adhesion tests confirmed reduced apparent Young's modulus and increased adhesion force in keratoconus. In conclusion, this study presents a novel, interpretable, in vivo, video-driven framework that supports early differential diagnosis and personalized intervention. This approach has clinical potential for precision medicine.