Corneal confocal microscopy: A novel noninvasive test to diagnose and stratify the severity of human diabetic neuropathy

Mitra Tavakoli, Cristian Quattrini, Caroline Abbott, Panagiotis Kallinikos, Andrew Marshall, Joanne Finnigan, Philip Morgan, Nathan Efron, Andrew J M Boulton, Rayaz Malik

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Abstract

OBJECTIVE - The accurate quantification of human diabetic neuropathy is important to define at-risk patients, anticipate deterioration, and assess new therapies. RESEARCH DESIGN AND METHODS - A total of 101 diabetic patients and 17 age-matched control subjects underwent neurological evaluation, neurophysiology tests, quantitative sensory testing, and evaluation of corneal sensation and corneal nerve morphology using corneal confocal microscopy (CCM). RESULTS - Corneal sensation decreased significantly (P = 0.0001) with increasing neuropathic severity and correlated with the neuropathy disability score (NDS) (r = 0.441, P < 0.0001). Corneal nerve fiber density (NFD) (P < 0.0001), nerve fiber length (NFL), (P < 0.0001), and nerve branch density (NBD) (P < 0.0001) decreased significantly with increasing neuropathic severity and correlated with NDS (NFD r = -0.475, P < 0.0001; NBD r = -0.511, P < 0.0001; and NFL r = -0.581, P < 0.0001). NBD and NFL demonstrated a significant and progressive reduction with worsening heat pain thresholds (P = 0.01). Receiver operating characteristic curve analysis for the diagnosis of neuropathy (NDS >3) defined an NFD of <27.8/mm 2 with a sensitivity of 0.82 (95% CI 0.68-0.92) and specificity of 0.52 (0.40-0.64) and for detecting patients at risk of foot ulceration (NDS >6) defined a NFD cutoff of <20.8/mm 2 with a sensitivity of 0.71 (0.42-0.92) and specificity of 0.64 (0.54-0.74). CONCLUSIONS - CCM is a noninvasive clinical technique that may be used to detect early nerve damage and stratify diabetic patients with increasing neuropathic severity.

Original languageEnglish
Pages (from-to)1792-1797
Number of pages6
JournalDiabetes Care
Volume33
Issue number8
DOIs
Publication statusPublished - Aug 2010
Externally publishedYes

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Tavakoli, M., Quattrini, C., Abbott, C., Kallinikos, P., Marshall, A., Finnigan, J., Morgan, P., Efron, N., Boulton, A. J. M., & Malik, R. (2010). Corneal confocal microscopy: A novel noninvasive test to diagnose and stratify the severity of human diabetic neuropathy. Diabetes Care, 33(8), 1792-1797. https://doi.org/10.2337/dc10-0253