Standardizing corneal nerve fibre length for nerve tortuosity increases its association with measures of diabetic neuropathy

Edwards, K., Pritchard, N., Vagenas, D., Russell, A., Malik, R. A. and Efron, N. (2014) Standardizing corneal nerve fibre length for nerve tortuosity increases its association with measures of diabetic neuropathy. Diabetic Medicine, 31 10: 1205-1209. doi:10.1111/dme.12466


Author Edwards, K.
Pritchard, N.
Vagenas, D.
Russell, A.
Malik, R. A.
Efron, N.
Title Standardizing corneal nerve fibre length for nerve tortuosity increases its association with measures of diabetic neuropathy
Journal name Diabetic Medicine   Check publisher's open access policy
ISSN 0742-3071
1464-5491
Publication date 2014-10
Sub-type Article (original research)
DOI 10.1111/dme.12466
Open Access Status
Volume 31
Issue 10
Start page 1205
End page 1209
Total pages 5
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2015
Language eng
Formatted abstract
Aims Recent studies on corneal markers have advocated corneal nerve fibre length as the most important measure of diabetic peripheral neuropathy. The aim of this study was to determine if standardizing corneal nerve fibre length for tortuosity increases its association with other measures of diabetic peripheral neuropathy.

Methods Two hundred and thirty-one individuals with diabetes with either predominantly mild or absent neuropathic changes and 61 control subjects 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 and corneal nerve fibre tortuosity were measured using corneal confocal microscopy. A tortuosity-standardised corneal nerve fibre length variable was generated by dividing corneal nerve fibre length by corneal nerve fibre tortuosity. Differences in corneal nerve morphology between individuals with and without diabetic peripheral neuropathy and control subjects were determined and associations were estimated between corneal morphology and established tests of, and risk factors for, diabetic peripheral neuropathy.

Results The tortuosity-standardised corneal nerve fibre length variable was better than corneal nerve fibre length in demonstrating differences between individuals with diabetes, with and without neuropathy (tortuosity-standardised corneal nerve fibre length variable: 70.5 ± 27.3 vs. 84.9 ± 28.7, P < 0.001, receiver operating characteristic area under the curve = 0.67; corneal nerve fibre length: 15.9 ± 6.9 vs. 18.4 ± 6.2 mm/mm2, P = 0.004, receiver operating characteristic area under the curve = 0.64). Furthermore, the tortuosity-standardised corneal nerve fibre length variable demonstrated a significant difference between the control subjects and individuals with diabetes, without neuropathy, while corneal nerve fibre length did not (tortuosity-standardised corneal nerve fibre length variable: 94.3 ± 27.1 vs. 84.9 ± 28.7, P = 0.028; corneal nerve fibre length: 20.1 ± 6.3 vs. 18.4 ± 6.2 mm/mm2, P = 0.084). Correlations between corneal nerve fibre length and established measures of neuropathy and risk factors for neuropathy were higher when a correction was made for the nerve tortuosity.

Conclusions Standardizing corneal nerve fibre length for tortuosity enhances the ability to differentiate individuals with diabetes, with and without neuropathy.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Other title: "Standardising corneal nerve fibre length for nerve tortuosity increases its association with measures of diabetic neuropathy".

Published under "Short Report: Complications".

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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Created: Fri, 05 Dec 2014, 17:30:39 EST by Dr Anthony Russell on behalf of Medicine - Princess Alexandra Hospital