Utility of assessing nerve morphology in central cornea versus whorl area for diagnosing diabetic peripheral neuropathy

Nicola Pritchard, Cirous Dehghani, Katie Edwards, Edward Burgin, Nick Cheang, Hannah Kim, Merna Mikhaiel, Gemma Stanton, Anthony W. Russell, Rayaz Malik, Nathan Efron

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Purpose: To compare small nerve fiber damage in the central cornea and whorl area in participants with diabetic peripheral neuropathy (DPN) and to examine the accuracy of evaluating these 2 anatomical sites for the diagnosis of DPN. Methods: A cohort of 187 participants (107 with type 1 diabetes and 80 controls) was enrolled. The neuropathy disability score (NDS) was used for the identification of DPN. The corneal nerve fiber length at the central cornea (CNFLcenter) and whorl (CNFLwhorl) was quantified using corneal confocal microscopy and a fully automated morphometric technique and compared according to the DPN status. Receiver operating characteristic analyses were used to compare the accuracy of the 2 corneal locations for the diagnosis of DPN. Results: CNFLcenter and CNFLwhorl were able to differentiate all 3 groups (diabetic participants with and without DPN and controls) (P < 0.001). There was a weak but significant linear relationship for CNFLcenter and CNFLwhorl versus NDS (P < 0.001); however, the corneal location × NDS interaction was not statistically significant (P = 0.17). The area under the receiver operating characteristic curve was similar for CNFLcenter and CNFLwhorl (0.76 and 0.77, respectively, P = 0.98). The sensitivity and specificity of the cutoff points were 0.9 and 0.5 for CNFLcenter and 0.8 and 0.6 for CNFLwhorl. Conclusions: Small nerve fiber pathology is comparable at the central and whorl anatomical sites of the cornea. Quantification of CNFL from the corneal center is as accurate as CNFL quantification of the whorl area for the diagnosis of DPN.

Original languageEnglish
Pages (from-to)756-761
Number of pages6
JournalCornea
Volume34
Issue number7
DOIs
Publication statusPublished - 7 Apr 2015

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Diabetic Neuropathies
Peripheral Nervous System Diseases
Cornea
Nerve Fibers
ROC Curve
Type 1 Diabetes Mellitus
Confocal Microscopy
Pathology
Sensitivity and Specificity

Keywords

  • corneal confocal microscopy
  • corneal subbasal nerve plexus
  • diabetic peripheral neuropathy

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)

Cite this

Pritchard, N., Dehghani, C., Edwards, K., Burgin, E., Cheang, N., Kim, H., ... Efron, N. (2015). Utility of assessing nerve morphology in central cornea versus whorl area for diagnosing diabetic peripheral neuropathy. Cornea, 34(7), 756-761. https://doi.org/10.1097/ICO.0000000000000447

Utility of assessing nerve morphology in central cornea versus whorl area for diagnosing diabetic peripheral neuropathy. / Pritchard, Nicola; Dehghani, Cirous; Edwards, Katie; Burgin, Edward; Cheang, Nick; Kim, Hannah; Mikhaiel, Merna; Stanton, Gemma; Russell, Anthony W.; Malik, Rayaz; Efron, Nathan.

In: Cornea, Vol. 34, No. 7, 07.04.2015, p. 756-761.

Research output: Contribution to journalArticle

Pritchard, N, Dehghani, C, Edwards, K, Burgin, E, Cheang, N, Kim, H, Mikhaiel, M, Stanton, G, Russell, AW, Malik, R & Efron, N 2015, 'Utility of assessing nerve morphology in central cornea versus whorl area for diagnosing diabetic peripheral neuropathy', Cornea, vol. 34, no. 7, pp. 756-761. https://doi.org/10.1097/ICO.0000000000000447
Pritchard, Nicola ; Dehghani, Cirous ; Edwards, Katie ; Burgin, Edward ; Cheang, Nick ; Kim, Hannah ; Mikhaiel, Merna ; Stanton, Gemma ; Russell, Anthony W. ; Malik, Rayaz ; Efron, Nathan. / Utility of assessing nerve morphology in central cornea versus whorl area for diagnosing diabetic peripheral neuropathy. In: Cornea. 2015 ; Vol. 34, No. 7. pp. 756-761.
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AU - Dehghani, Cirous

AU - Edwards, Katie

AU - Burgin, Edward

AU - Cheang, Nick

AU - Kim, Hannah

AU - Mikhaiel, Merna

AU - Stanton, Gemma

AU - Russell, Anthony W.

AU - Malik, Rayaz

AU - Efron, Nathan

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N2 - Purpose: To compare small nerve fiber damage in the central cornea and whorl area in participants with diabetic peripheral neuropathy (DPN) and to examine the accuracy of evaluating these 2 anatomical sites for the diagnosis of DPN. Methods: A cohort of 187 participants (107 with type 1 diabetes and 80 controls) was enrolled. The neuropathy disability score (NDS) was used for the identification of DPN. The corneal nerve fiber length at the central cornea (CNFLcenter) and whorl (CNFLwhorl) was quantified using corneal confocal microscopy and a fully automated morphometric technique and compared according to the DPN status. Receiver operating characteristic analyses were used to compare the accuracy of the 2 corneal locations for the diagnosis of DPN. Results: CNFLcenter and CNFLwhorl were able to differentiate all 3 groups (diabetic participants with and without DPN and controls) (P < 0.001). There was a weak but significant linear relationship for CNFLcenter and CNFLwhorl versus NDS (P < 0.001); however, the corneal location × NDS interaction was not statistically significant (P = 0.17). The area under the receiver operating characteristic curve was similar for CNFLcenter and CNFLwhorl (0.76 and 0.77, respectively, P = 0.98). The sensitivity and specificity of the cutoff points were 0.9 and 0.5 for CNFLcenter and 0.8 and 0.6 for CNFLwhorl. Conclusions: Small nerve fiber pathology is comparable at the central and whorl anatomical sites of the cornea. Quantification of CNFL from the corneal center is as accurate as CNFL quantification of the whorl area for the diagnosis of DPN.

AB - Purpose: To compare small nerve fiber damage in the central cornea and whorl area in participants with diabetic peripheral neuropathy (DPN) and to examine the accuracy of evaluating these 2 anatomical sites for the diagnosis of DPN. Methods: A cohort of 187 participants (107 with type 1 diabetes and 80 controls) was enrolled. The neuropathy disability score (NDS) was used for the identification of DPN. The corneal nerve fiber length at the central cornea (CNFLcenter) and whorl (CNFLwhorl) was quantified using corneal confocal microscopy and a fully automated morphometric technique and compared according to the DPN status. Receiver operating characteristic analyses were used to compare the accuracy of the 2 corneal locations for the diagnosis of DPN. Results: CNFLcenter and CNFLwhorl were able to differentiate all 3 groups (diabetic participants with and without DPN and controls) (P < 0.001). There was a weak but significant linear relationship for CNFLcenter and CNFLwhorl versus NDS (P < 0.001); however, the corneal location × NDS interaction was not statistically significant (P = 0.17). The area under the receiver operating characteristic curve was similar for CNFLcenter and CNFLwhorl (0.76 and 0.77, respectively, P = 0.98). The sensitivity and specificity of the cutoff points were 0.9 and 0.5 for CNFLcenter and 0.8 and 0.6 for CNFLwhorl. Conclusions: Small nerve fiber pathology is comparable at the central and whorl anatomical sites of the cornea. Quantification of CNFL from the corneal center is as accurate as CNFL quantification of the whorl area for the diagnosis of DPN.

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KW - corneal subbasal nerve plexus

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