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Xin Chen, Jim Graham, Ioannis N. Petropoulos, Georgios Ponirakis, Omar Asghar, Uazman Alam, Andrew Marshall, Maryam Ferdousi, Shazli Azmi, Nathan Efron, Rayaz A. Malik; Corneal Nerve Fractal Dimension: A Novel Corneal Nerve Metric for the Diagnosis of Diabetic Sensorimotor Polyneuropathy. Invest. Ophthalmol. Vis. Sci. 2018;59(2):1113-1118. doi: https://doi.org/10.1167/iovs.17-23342.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, is a noninvasive and objective imaging biomarker for identifying small nerve fiber damage. We have evaluated the diagnostic performance of previously established CCM parameters to a novel automated measure of corneal nerve complexity called the corneal nerve fiber fractal dimension (ACNFrD).
A total of 176 subjects (84 controls and 92 patients with type 1 diabetes) with and without diabetic sensorimotor polyneuropathy (DSPN) underwent CCM. Fractal dimension analysis was performed on CCM images using purpose-built corneal nerve analysis software, and compared with previously established manual and automated corneal nerve fiber measurements.
Manual and automated subbasal corneal nerve fiber density (CNFD) (P < 0.0001), length (CNFL) (P < 0.0001), branch density (CNBD) (P < 0.05), and ACNFrD (P < 0.0001) were significantly reduced in patients with DSPN compared to patients without DSPN. The areas under the receiver operating characteristic curves for identifying DSPN were comparable: 0.77 for automated CNFD, 0.74 for automated CNFL, 0.69 for automated CNBD, and 0.74 for automated ACNFrD.
ACNFrD shows comparable diagnostic efficiency to identify diabetic patients with and without DSPN.
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