Corneal sensitivity as an ophthalmic marker of diabetic neuropathy

Pritchard, Nicola, Edwards, Katie P., Vagenas, Dimitrios, Moavenshahidi, Ayda, Sampson, Geoff, Russell, Anthony, Malik, Rayaz A., & Efron, Nathan (2010) Corneal sensitivity as an ophthalmic marker of diabetic neuropathy. Optometry and Vision Science, 87(12), pp. 1003-1008.

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Purpose. 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.

Methods. 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 used.

Results. 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%.

Conclusions. 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.

Impact and interest:

18 citations in Scopus
16 citations in Web of Science®
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ID Code: 39846
Item Type: Journal Article
Refereed: Yes
Additional Information: ACKNOWLEDGMENTS
This study funded by the American Optometric Foundation (CT11663), the National Health and Medical Research Council of Australia (497230), and the Juvenile Diabetes Research Foundation International (8-2008-362).
Keywords: Non-Contact Corneal Esthesiometry, Corneal Sensitivity, Neuropathy Disability Score, Ophthalmic Markers, Diabetic Neuropathy
DOI: 10.1097/OPX.0b013e3181fd6188
ISSN: 1040-5488
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Optometry & Vision Science
Copyright Owner: Copyright: © 2010 American Academy of Optometry
Deposited On: 02 Feb 2011 02:17
Last Modified: 29 Feb 2012 14:28

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