August 2015
Volume 56, Issue 9
Letters to the Editor  |   August 2015
Author Response: Small Fiber Neuropathy and Wilson Disease
Author Affiliations & Notes
  • Edoardo Midena
    Department of Ophthalmology, University of Padova, Padova, Italy
    Ocular Oncology and Toxicology Research Unit, G.B. Bietti Foundation, IRCCS, Roma, Italy.
Investigative Ophthalmology & Visual Science August 2015, Vol.56, 5331. doi:
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      Edoardo Midena; Author Response: Small Fiber Neuropathy and Wilson Disease. Invest. Ophthalmol. Vis. Sci. 2015;56(9):5331. doi:

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

  • Supplements
We appreciate the comments that Gondim and Gurgen Filha1 have reported about our article,2 which has demonstrated, for the first time, corneal nerve fiber involvement in Wilson disease documented by corneal confocal microscopy. They report the use of confocal microscopy, not corneal but reflectance skin confocal microscopy, to determine Meissner corpuscle changes in sensory neuropathy, a different field of investigation compared with our article.3 Moreover, the original article was written by Herrmann et al.4 It is not new that corneal confocal microscopy is able to demostrate small fiber peripheral neuropathy in diabetes, and we were the first research group to introduce in the literature the term “corneal diabetic neuropathy,” in 2006.5 We have reviewed the article by Gondim et al.6 about small fiber dysfunction in Wilson disease, but it has nothing to do with our investigation. Skin wrinkling test has never been compared with corneal confocal study of subbasal nerve plexus, and it may represent a topic for future studies. In our population, we did not find any difference in corneal involvement, even when separately evaluating central nervous system versus pure hepatic involvement. We congratulate Gondim et al.6 for their prospective studies, and we hope they are able to include the evaluation of cornal subasal nerve plexus by corneal confocal microscopy in their prospective analysis. 
Gondim FAA, Gurgel Filha JH, . Small fiber neuropathy and Wilson disease. Invest Ophthalmol Vis Sci. 2015; 56: 5330.
Sturniolo GC, Lazzarini D, Bartolo O, et al. Small fiber peripheral neuropathy in Wilson disease: an in vivo documentation by corneal confocal microscopy. Invest Ophthalmol Vis Sci. 2015; 56: 1390–1395.
Nolano M, Provitera V, Santoro L, et al. In vivo confocal microscopy of Meissner corpuscles as a measure of sensory neuropathy. Neurology. 2008; 71: 536–537.
Herrmann DN, Boger JN, Jansen C, Alessi-Fox C. In vivo confocal microscopy of Meissner corpuscles as a measure of sensory neuropathy. Neurology. 2007; 69: 2121–2127.
Midena E, Brugin E, Ghirlando A, Sommavilla M, Avogaro A. Corneal diabetic neuropathy: a confocal microscopy study. J Refract Surg. 2006; 22: S1047–S1052.
Gondim Fde A, Araújo DF, Oliveira IS, Vale OC. Small fiber dysfunction in patients with Wilson's disease. Arq Neuropsiquiatr. 2014; 72: 592–595.

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