June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Corneal Confocal Microscopy for Early Detection of Diabetic Neuropathy in Newly Diagnosed Patients with Type 2 Diabetes Mellitus
Author Affiliations & Notes
  • Mitra Tavakoli
    University of Exeter Medical School , Exeter, United Kingdom
    NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, United Kingdom
  • Claudia Soiland-Reyes
    NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, United Kingdom
  • Rebecca Spencer
    NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, United Kingdom
  • Susan Howard
    NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, United Kingdom
  • Ruth Boaden
    NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, United Kingdom
  • Footnotes
    Commercial Relationships   Mitra Tavakoli, None; Claudia Soiland-Reyes, None; Rebecca Spencer, None; Susan Howard, None; Ruth Boaden, None
  • Footnotes
    Support  NIHR - CLAHRC GM
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1014. doi:
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      Mitra Tavakoli, Claudia Soiland-Reyes, Rebecca Spencer, Susan Howard, Ruth Boaden; Corneal Confocal Microscopy for Early Detection of Diabetic Neuropathy in Newly Diagnosed Patients with Type 2 Diabetes Mellitus
      . Invest. Ophthalmol. Vis. Sci. 2017;58(8):1014.

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

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Abstract

Purpose : Screening for presence and severity of Diabetic Peripheral Neuropathy with using Corneal Confocal Microscopy in a cohort of newly diagnosed type 2 diabetic mellitus patients.

Methods : After screening 460 diabetic patients, 91 newly diagnosed type 2 diabetic patients (62% male, Age: 63±12; Ethnicity: 80% Caucasian,14.4% Afro-Caribbean; 5% South Asians) have been screened for Diabetic Peripheral Neuropathy (DPN) with using corneal confocal microscopy (HRT III- RCM), alongside of 60 age and sex matched healthy control subjects (65% male, Age: 62±14). All patients were part of South Manchester Screening Programme and have been screened for diabetic retinopathy at the same visit by four independent, experienced optometrists that have been trained for CCM. Selection of CCM images was done by optometrists and after sending the images to leading centre, images have been graded and analysed at the leading centre. Retinopathy grading has been done by optometrists based on national retinopathy screening programme (ETDRS).
As part of this screening programme, all patients filled some questionnaires including Diabetic Neuropathy Symptoms profile (DNS) and self-reported questionnaires regards to the history of retinopathy, retinopathy laser treatment, diabetic foot problem, foot ulcer and neuropathy.

Results : Average duration of diabetes was 1 year (1.04± 0.07). 80% of patients had no retinopathy and 19.7% of patients had background retinopathy. 15.3% of patients had symptoms of diabetic neuropathy (DNS>1).
There was significant alterations in corneal nerves morphological parameters in patients compare to control subjects including CNFD (P<0.001); CNBD (P=0.007); CNFL (P<0.001), and size of beading along c-nerve fibres (P<0.001).
CNFD and CNFL were reduced below the 2.5th percentile in 15.5%, and 14.4% of the diabetes patients, respectively.
There was no correlation between neuropathy symptoms and severity of alterations of corneal nerves. No correlation has been also found for retinopathy and neuropathy.

Conclusions : As part of a bigger screening programme, feasibility and acceptability of using CCM alongside retinopathy screening have been established. This study showed the significant level of nerve damage and presence of DPN in newly diagnosed type 2 diabetic patients without evidence of other microvascular complications.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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