June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Longitudinal Assessment of Neuropathy in Diabetes using novel ophthalmic MARKers (LANDMark): Baseline findings
Author Affiliations & Notes
  • Nathan Efron
    Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
    School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia
  • Nicola Pritchard
    Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
    School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia
  • Katie Edwards
    Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
    School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia
  • Geoff Sampson
    Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
    School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, QLD, Australia
  • Anthony Russell
    Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
    School of Medicine, University of Queensland, St Lucia, QLD, Australia
  • Ioannis Petropoulos
    School of Medicine, University of Queensland, St Lucia, QLD, Australia
    Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom
  • Uazman Alam
    School of Medicine, University of Queensland, St Lucia, QLD, Australia
    Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom
  • Hassan Fadavi
    School of Medicine, University of Queensland, St Lucia, QLD, Australia
    Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom
  • Mitra Tavakoli
    School of Medicine, University of Queensland, St Lucia, QLD, Australia
    Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom
  • Rayaz Malik
    School of Medicine, University of Queensland, St Lucia, QLD, Australia
    Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom
  • Footnotes
    Commercial Relationships Nathan Efron, None; Nicola Pritchard, None; Katie Edwards, None; Geoff Sampson, None; Anthony Russell, None; Ioannis Petropoulos, None; Uazman Alam, None; Hassan Fadavi, None; Mitra Tavakoli, None; Rayaz Malik, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 2578. doi:
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      Nathan Efron, Nicola Pritchard, Katie Edwards, Geoff Sampson, Anthony Russell, Ioannis Petropoulos, Uazman Alam, Hassan Fadavi, Mitra Tavakoli, Rayaz Malik; Longitudinal Assessment of Neuropathy in Diabetes using novel ophthalmic MARKers (LANDMark): Baseline findings. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2578.

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

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Abstract

Purpose: Over the past decade, corneal nerve morphology and corneal sensation threshold have been explored as potential surrogate markers for the evaluation of diabetic neuropathy. We present the baseline findings of a Longitudinal Assessment of Neuropathy in Diabetes using novel ophthalmic Markers (LANDMark).

Methods: The LANDMark Study is a 5-year, two-site, natural history (observational) study of individuals with Type 1 diabetes stratified into those with (T1W) and without (T1WO) neuropathy according to the Toronto criteria, and control subjects. All study participants undergo detailed annual assessment of neuropathy including corneal nerve parameters measured using corneal confocal microscopy and corneal sensitivity measured using non-contact corneal esthesiometry.

Results: 396 eligible individuals (208 in Brisbane and 188 in Manchester) were assessed: 76 T1W, 166 T1WO and 154 controls. Corneal sensation threshold (mbars) was significantly higher in T1W (1.0 ± 1.1) than T1WO (0.7 ± 0.7) and controls (0.6 ± 0.4) (P=0.002); post-hoc analysis (PHA) revealed no difference between T1WO and controls (Tukey HSD, P=0.502). Corneal nerve fiber length (mm/mm2) (CNFL) was lower in T1W (13.8 ± 6.4) than T1WO (19.1 ± 5.8) and controls (23.2 ± 6.3) (P<0.001); PHA revealed CNFL to be lower in T1W than T1WO, and lower in both of these groups than controls (P<0.001). Corneal nerve branch density (branches/mm2) (CNBD) was significantly lower in T1W (40 ± 32) than T1WO (62 ± 37) and controls (83 ± 46) (P<0.001); PHA showed CNBD was lower in T1W than T1WO, and lower in both groups than controls (P<0.001). Alcohol and cigarette consumption did not differ between groups, although age, BMI, BP, waist circumference, HbA1c, albumin-creatinine ratio, and cholesterol were slightly greater in T1W than T1WO (p<0.05). Some site differences were observed.

Conclusions: The LANDMark baseline findings confirm that corneal sensitivity and corneal nerve morphometry can detect differences in neuropathy status in individuals with Type 1 diabetes and healthy controls. Corneal nerve morphology is significantly abnormal even in diabetic patients ‘without neuropathy’ compared to control participants. Results of the longitudinal trial will assess the capability of these tests for monitoring change in these parameters over time as potential surrogate markers for neuropathy.

Keywords: 498 diabetes • 482 cornea: epithelium  
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