A critical review of the progress and application of finite element models in corneal biomechanics

Corneal morphology and biomechanics are the primary determinants of visual quality. Accurate biomechanical characterization is essential for optimizing the outcomes of refractive surgery and managing pathologies such as keratoconus. Finite element modeling is an established method used to simulate surgical procedures, predict mechanical responses, and investigate pathological mechanisms. This review evaluates the progression of corneal finite element models. Early work relied on idealized two-dimensional cross-sections or simplified three-dimensional shapes; today, researchers routinely build personalized, high-resolution three-dimensional reconstructions directly from clinical image data. Material descriptions have moved from basic isotropic linear elasticity to advanced hyperelastic, anisotropic, and viscoelastic formulations that more accurately simulate the physiological corneal behavior. This review also covers concrete applications in refractive surgery planning, corneal cross-linking optimization, and mechanistic studies of corneal pathology, as well as extensions to transplantation and orthokeratology. Taken together, these models provide reliable biomechanical evidence that supports individualized surgical design, refined cross-linking parameters, and improved graft assessment, steps that can increase the predictability and safety of modern ophthalmic procedures.