Utility of corneal confocal microscopy for assessing mild diabetic neuropathy: Baseline findings of the LANDMark study

Edwards, Katie, Pritchard, Nicola, Vagenas, Dimitrios, Russell, Anthony, Malik, Rayaz A. and Efron, Nathan (2012) Utility of corneal confocal microscopy for assessing mild diabetic neuropathy: Baseline findings of the LANDMark study. Clinical and Experimental Optometry, 95 3: 348-354. doi:10.1111/j.1444-0938.2012.00740.x

Author Edwards, Katie
Pritchard, Nicola
Vagenas, Dimitrios
Russell, Anthony
Malik, Rayaz A.
Efron, Nathan
Title Utility of corneal confocal microscopy for assessing mild diabetic neuropathy: Baseline findings of the LANDMark study
Journal name Clinical and Experimental Optometry   Check publisher's open access policy
ISSN 0816-4622
Publication date 2012-05
Sub-type Article (original research)
DOI 10.1111/j.1444-0938.2012.00740.x
Volume 95
Issue 3
Start page 348
End page 354
Total pages 7
Editor Nathan Efron
Erica Fletcher
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2013
Language eng
Formatted abstract
Background: For those in the field of managing diabetic complications, the accurate diagnosis and monitoring of diabetic peripheral neuropathy (DPN) continues to be a challenge. Assessment of sub-basal corneal nerve morphology has recently shown promise as a novel ophthalmic marker for the detection of DPN.
Methods: Two hundred and thirty-one individuals with diabetes with predominantly mild or no neuropathy and 61 controls underwent evaluation of diabetic neuropathy symptom score, neuropathy disability score, testing with 10 g monofilament, quantitative sensory testing (warm, cold, vibration detection) and nerve conduction studies. Corneal nerve fibre length, branch density and tortuosity were measured using corneal confocal microscopy. Differences in corneal nerve morphology between individuals with and without DPN and controls were investigated using analysis of variance and correlations were determined between corneal morphology and established tests of, and risk factors for, DPN.
Results: Corneal nerve fibre length was significantly reduced in diabetic individuals with mild DPN compared with both controls (p < 0.001) and diabetic individuals without DPN (p = 0.012). Corneal nerve branch density was significantly reduced in individuals with mild DPN compared with controls (p = 0.032). Corneal nerve fibre tortuosity did not show significant differences. Corneal nerve fibre length and corneal nerve branch density showed modest correlations to most measures of neuropathy, with the strongest correlations to nerve conduction study parameters (r = 0.15 to 0.25). Corneal nerve fibre tortuosity showed only a weak correlation to the vibration detection threshold. Corneal nerve fibre length was inversely correlated to glycated haemoglobin (r = -0.24) and duration of diabetes (r = -0.20).
Conclusion: Assessment of corneal nerve morphology is a non-invasive, rapid test capable of showing differences between individuals with and without DPN. Corneal nerve fibre length shows the strongest associations with other diagnostic tests of neuropathy and with established risk factors for neuropathy.
Keyword Confocal microscopy
Corneal nerves
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Special issue on Diabetes and the Eye

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
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