Corneal sensitivity as an ophthalmic marker of diabetic neuropathy

Pritchard, Nicola, Edwards, Katie, Vagenas, Dimitrios, Shahidi, Ayda M., Sampson, Geoff P., Russell, Anthony W., Malik, Rayaz A. and Efron, Nathan (2010) Corneal sensitivity as an ophthalmic marker of diabetic neuropathy. Optometry and Vision Science, 87 12: 1003-1008. doi:10.1097/OPX.0b013e3181fd6188

Author Pritchard, Nicola
Edwards, Katie
Vagenas, Dimitrios
Shahidi, Ayda M.
Sampson, Geoff P.
Russell, Anthony W.
Malik, Rayaz A.
Efron, Nathan
Title Corneal sensitivity as an ophthalmic marker of diabetic neuropathy
Journal name Optometry and Vision Science   Check publisher's open access policy
ISSN 1040-5488
Publication date 2010-12-01
Sub-type Article (original research)
DOI 10.1097/OPX.0b013e3181fd6188
Open Access Status DOI
Volume 87
Issue 12
Start page 1003
End page 1008
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 111301 Ophthalmology
110306 Endocrinology
Formatted abstract
The objective of this study was to explore the discriminative capacity of non-contact corneal esthesiometry
(NCCE) when compared with the neuropathy disability score (NDS) score—a validated, standard method of diagnosing
clinically significant diabetic neuropathy.


Eighty-one participants with type 2 diabetes, no history of ocular disease, trauma, or surgery and no history of
systemic disease that may affect the cornea were enrolled. Participants were ineligible if there was history of neuropathy
due to non-diabetic cause or current diabetic foot ulcer or infection. Corneal sensitivity threshold was measured on the
eye of dominant hand side at a distance of 10 mm from the center of the cornea using a stimulus duration of 0.9 s. The
NDS was measured producing a score ranging from 0 to 10. To determine the optimal cutoff point of corneal sensitivity
that identified the presence of neuropathy (diagnosed by NDS), the Youden index and “closest-to-(0,1)” criteria were


The receiver-operator characteristic curve for NCCE for the presence of neuropathy (NDS 3) had an area under
the curve of 0.73 (p 0.001) and, for the presence of moderate neuropathy (NDS 6), area of 0.71 (p 0.003). By using
the Youden index, for an NDS 3, the sensitivity of NCCE was 70% and specificity was 75%, and a corneal sensitivity
threshold of 0.66 mbar or higher indicated the presence of neuropathy. When NDS 6 (indicating risk of foot ulceration)
was applied, the sensitivity was 52% with a specificity of 85%.


NCCE is a sensitive test for the diagnosis of minimal and more advanced diabetic neuropathy and may serve
as a useful surrogate marker for diabetic and perhaps other neuropathies.
(Optom Vis Sci 2010;87:1003–1008
Keyword Non-contact corneal esthesiometry
Corneal sensitivity
Neuropathy disability score
Ophthalmic markers
Diabetic neuropathy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 23 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 24 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 09 Dec 2010, 08:09:34 EST by Dr Anthony Russell on behalf of Medicine - Princess Alexandra Hospital