September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Repeatability and clinical utility of a novel method to measure in-vivo corneal nerve migration in diabetic neuropathy
Author Affiliations & Notes
  • Katie Edwards
    School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Gove, Queensland, Australia
  • Khaled Al Rashah
    School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Gove, Queensland, Australia
  • Nicola Pritchard
    School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Gove, Queensland, Australia
  • Christopher Poole
    School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Gove, Queensland, Australia
  • Cirous Dehghani
    School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Gove, Queensland, Australia
  • Anthony Russell
    School of Medicine, University of Queensland, Brisbane, Queensland, Australia
    Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Rayaz A Malik
    Center for Endocrinology and Diabetes and Institute of Human Development, University of Manchester, Manchester, United Kingdom
    Weill Cornell Medical College in Qatar, Doha, Qatar
  • Nathan Efron
    School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Gove, Queensland, Australia
  • Footnotes
    Commercial Relationships   Katie Edwards, None; Khaled Al Rashah, None; Nicola Pritchard, None; Christopher Poole, None; Cirous Dehghani, None; Anthony Russell, None; Rayaz Malik, None; Nathan Efron, None
  • Footnotes
    Support  Juvenile Diabetes Research Foundation Grants 8-2008-362 and 3-2013-211
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1922. doi:
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      Katie Edwards, Khaled Al Rashah, Nicola Pritchard, Christopher Poole, Cirous Dehghani, Anthony Russell, Rayaz A Malik, Nathan Efron; Repeatability and clinical utility of a novel method to measure in-vivo corneal nerve migration in diabetic neuropathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1922.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We developed a novel technique to measure in-vivo corneal nerve migration, and determined its repeatability and clinical utility in diabetic neuropathy.

Methods : Wide-field montages of the sub-basal corneal nerve plexus were generated at baseline and after three weeks for 14 participants (control participants (n=4); diabetic participants without (n=5) and with (n=5) neuropathy). Montages were manually examined side by side to identify a referent landmark in the inferior whorl region and 20 additional nerve landmarks throughout each montage. An algorithm was developed to measure nerve migration by quantifying the movement of the nerve landmarks relative to the inferior whorl landmark over the three-week period, with migration reported in microns per week. Intra- and inter-observer repeatabilities were determined by measurement of nerve migration on the pair of montaged images by one researcher on two occasions, five days apart, and by two observers respectively. A paired t-test was used to compare the difference between the two measurements. Bland–Altman plots were generated to assess agreement and the intra-class correlation coefficient (ICC) was calculated to estimate repeatability. To illustrate it’s clinical utility, we compared the average nerve migration between the three groups.

Results : The mean difference between observations 1 and 2 was 0.92 µm/week (p=0.10), with an ICC of 0.99 (95% confidence interval (CI)=0.99-1.00). The mean difference between observer 1 and 2 was 3.05 µm/week (p=0.04), with an ICC of 0.97 (95% CI=0.91-0.99). Movement of individual points was dependent on their distance from the inferior whorl, so the method was altered to keep the distance of the measured points at an average of 1,200±50µm from the inferior whorl. Using this method, the mean difference between observers was 0.38 µm/week (p=0.38), with an ICC of 0.97 (95% CI=0.99-1.00). The average nerve migration rate was 32.7, 53.4 and 45.3 µm/week for the diabetic individuals with and without neuropathy and the control participants, respectively (p=0.18).

Conclusions : This novel imaging technique allows repeatable and non-invasive measurement of in-vivo corneal nerve migration. The results indicate that patients with diabetic neuropathy may have a reduced rate of nerve migration, which should be explored in future studies.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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