Corneal confocal microscopy for the diagnosis of diabetic autonomic neuropathy

Mitra Tavakoli, Piyara Begum, John Mclaughlin, Rayaz Malik

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Diabetic autonomic neuropathy (DAN) results in increased morbidity and mortality. The early diagnosis of DAN can be difficult and is commonly evaluated using cardiac autonomic function tests as a surrogate. However, they are not widely available, have limited sensitivity and specificity, and can be confounded by concomitant cardiovascular disease and medications. Methods: The diagnostic utility of corneal confocal microscopy for diagnosis of DAN was assessed. Thirty-four diabetic patients without [Composite Autonomic Scoring Scale (CASS)≤2] vs with (CASS>2) DAN and 18 healthy control subjects (HC) underwent detailed assessment of somatic and autonomic neuropathy, Composite Autonomic Symptom Scale (COMPASS), (CASS), and Corneal Confocal Microscopy (CCM). Results: Corneal nerve fiber density, branch density, and length showed a progressive and significant reduction in patients with DAN vs HC and those without DAN. CCM correlated highly significantly with COMPASS and CASS, and corneal nerve fiber parameters demonstrated a high sensitivity and specificity for diagnosis of DAN. Conclusions: This study demonstrates that corneal nerve damage detected using CCM can be deployed to diagnose subclinical and overt DAN. It therefore represents a rapid, non-invasive, highly sensitive and specific diagnostic test for DAN.

Original languageEnglish
Pages (from-to)363-370
Number of pages8
JournalMuscle and Nerve
Volume52
Issue number3
DOIs
Publication statusPublished - 1 Sep 2015

Fingerprint

Diabetic Neuropathies
Confocal Microscopy
Nerve Fibers
Heart Function Tests
Healthy Volunteers
Sensitivity and Specificity
Routine Diagnostic Tests
Early Diagnosis
Cardiovascular Diseases
Morbidity
Mortality

Keywords

  • Autonomic Neuropathy
  • Corneal confocal microscopy
  • Corneal nerves
  • Diabetes

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Cellular and Molecular Neuroscience
  • Physiology (medical)

Cite this

Corneal confocal microscopy for the diagnosis of diabetic autonomic neuropathy. / Tavakoli, Mitra; Begum, Piyara; Mclaughlin, John; Malik, Rayaz.

In: Muscle and Nerve, Vol. 52, No. 3, 01.09.2015, p. 363-370.

Research output: Contribution to journalArticle

Tavakoli, Mitra ; Begum, Piyara ; Mclaughlin, John ; Malik, Rayaz. / Corneal confocal microscopy for the diagnosis of diabetic autonomic neuropathy. In: Muscle and Nerve. 2015 ; Vol. 52, No. 3. pp. 363-370.
@article{64600d159a3c4a3484918375cc4b29a6,
title = "Corneal confocal microscopy for the diagnosis of diabetic autonomic neuropathy",
abstract = "Background: Diabetic autonomic neuropathy (DAN) results in increased morbidity and mortality. The early diagnosis of DAN can be difficult and is commonly evaluated using cardiac autonomic function tests as a surrogate. However, they are not widely available, have limited sensitivity and specificity, and can be confounded by concomitant cardiovascular disease and medications. Methods: The diagnostic utility of corneal confocal microscopy for diagnosis of DAN was assessed. Thirty-four diabetic patients without [Composite Autonomic Scoring Scale (CASS)≤2] vs with (CASS>2) DAN and 18 healthy control subjects (HC) underwent detailed assessment of somatic and autonomic neuropathy, Composite Autonomic Symptom Scale (COMPASS), (CASS), and Corneal Confocal Microscopy (CCM). Results: Corneal nerve fiber density, branch density, and length showed a progressive and significant reduction in patients with DAN vs HC and those without DAN. CCM correlated highly significantly with COMPASS and CASS, and corneal nerve fiber parameters demonstrated a high sensitivity and specificity for diagnosis of DAN. Conclusions: This study demonstrates that corneal nerve damage detected using CCM can be deployed to diagnose subclinical and overt DAN. It therefore represents a rapid, non-invasive, highly sensitive and specific diagnostic test for DAN.",
keywords = "Autonomic Neuropathy, Corneal confocal microscopy, Corneal nerves, Diabetes",
author = "Mitra Tavakoli and Piyara Begum and John Mclaughlin and Rayaz Malik",
year = "2015",
month = "9",
day = "1",
doi = "10.1002/mus.24553",
language = "English",
volume = "52",
pages = "363--370",
journal = "Muscle and Nerve",
issn = "0148-639X",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Corneal confocal microscopy for the diagnosis of diabetic autonomic neuropathy

AU - Tavakoli, Mitra

AU - Begum, Piyara

AU - Mclaughlin, John

AU - Malik, Rayaz

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Background: Diabetic autonomic neuropathy (DAN) results in increased morbidity and mortality. The early diagnosis of DAN can be difficult and is commonly evaluated using cardiac autonomic function tests as a surrogate. However, they are not widely available, have limited sensitivity and specificity, and can be confounded by concomitant cardiovascular disease and medications. Methods: The diagnostic utility of corneal confocal microscopy for diagnosis of DAN was assessed. Thirty-four diabetic patients without [Composite Autonomic Scoring Scale (CASS)≤2] vs with (CASS>2) DAN and 18 healthy control subjects (HC) underwent detailed assessment of somatic and autonomic neuropathy, Composite Autonomic Symptom Scale (COMPASS), (CASS), and Corneal Confocal Microscopy (CCM). Results: Corneal nerve fiber density, branch density, and length showed a progressive and significant reduction in patients with DAN vs HC and those without DAN. CCM correlated highly significantly with COMPASS and CASS, and corneal nerve fiber parameters demonstrated a high sensitivity and specificity for diagnosis of DAN. Conclusions: This study demonstrates that corneal nerve damage detected using CCM can be deployed to diagnose subclinical and overt DAN. It therefore represents a rapid, non-invasive, highly sensitive and specific diagnostic test for DAN.

AB - Background: Diabetic autonomic neuropathy (DAN) results in increased morbidity and mortality. The early diagnosis of DAN can be difficult and is commonly evaluated using cardiac autonomic function tests as a surrogate. However, they are not widely available, have limited sensitivity and specificity, and can be confounded by concomitant cardiovascular disease and medications. Methods: The diagnostic utility of corneal confocal microscopy for diagnosis of DAN was assessed. Thirty-four diabetic patients without [Composite Autonomic Scoring Scale (CASS)≤2] vs with (CASS>2) DAN and 18 healthy control subjects (HC) underwent detailed assessment of somatic and autonomic neuropathy, Composite Autonomic Symptom Scale (COMPASS), (CASS), and Corneal Confocal Microscopy (CCM). Results: Corneal nerve fiber density, branch density, and length showed a progressive and significant reduction in patients with DAN vs HC and those without DAN. CCM correlated highly significantly with COMPASS and CASS, and corneal nerve fiber parameters demonstrated a high sensitivity and specificity for diagnosis of DAN. Conclusions: This study demonstrates that corneal nerve damage detected using CCM can be deployed to diagnose subclinical and overt DAN. It therefore represents a rapid, non-invasive, highly sensitive and specific diagnostic test for DAN.

KW - Autonomic Neuropathy

KW - Corneal confocal microscopy

KW - Corneal nerves

KW - Diabetes

UR - http://www.scopus.com/inward/record.url?scp=84938999548&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84938999548&partnerID=8YFLogxK

U2 - 10.1002/mus.24553

DO - 10.1002/mus.24553

M3 - Article

VL - 52

SP - 363

EP - 370

JO - Muscle and Nerve

JF - Muscle and Nerve

SN - 0148-639X

IS - 3

ER -