June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Deep-learning based analysis of in-vivo confocal microscopy-derived metrics of the corneal nerve whorl in eyes with neuropathic ocular pain and controls
Author Affiliations & Notes
  • nadim S. azar
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
  • Matias Soifer
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
    National Eye Institute, Bethesda, Maryland, United States
  • Zane Zemborain
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Seitaro Komai
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
  • Manuel Emiliano Quiroga-Garza
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
  • Hazem Mousa
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
  • Raul Eduardo Ruiz Lozano
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
  • James Tian
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Sina Farsiu
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Biomedical Engineering, Duke University, Durham, North Carolina, United States
  • Victor L Perez
    Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Foster Center for Ocular Immunology, Duke University Department of Ophthalmology, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   nadim azar None; Matias Soifer None; Zane Zemborain None; Seitaro Komai None; Manuel Quiroga-Garza None; Hazem Mousa None; Raul Ruiz Lozano None; James Tian None; Sina Farsiu None; Victor Perez Dompe, Novartis, Regentree, Santen, Code C (Consultant/Contractor), Alcon, EBN, NIH, Code F (Financial Support), Kiora, Trefoil, Code I (Personal Financial Interest)
  • Footnotes
    Support  NIH/NEI R01EY030283 (Dr. Perez), NIH/NEI R01EY024485 (Dr. Perez), 1U01EY034687-01 (Dr Farsiu, Dr Perez), Foster Center for Ocular Immunology (Duke University, Durham, NC), Duke NIH Center Core Grant 5P30EY005722-36 (Dr. Perez) and Duke Research to Prevent Blindness Unrestricted Grant (Dr. Perez)
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4018. doi:
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      nadim S. azar, Matias Soifer, Zane Zemborain, Seitaro Komai, Manuel Emiliano Quiroga-Garza, Hazem Mousa, Raul Eduardo Ruiz Lozano, James Tian, Sina Farsiu, Victor L Perez; Deep-learning based analysis of in-vivo confocal microscopy-derived metrics of the corneal nerve whorl in eyes with neuropathic ocular pain and controls. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4018.

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

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Abstract

Purpose : To compare in-vivo confocal microscopy (IVCM) metrics of sub-basal corneal nerves, immune cells, and neuromas patients with neuropathic ocular pain (NOP) and controls using deep learning-based automated segmentation and assess the validity of corneal nerve whorl detection

Methods : In-vivo confocal microscopy images of the corneal whorl were collected from 97 eyes (49 NOP, 48 Controls). Inclusion criteria for neuropathic ocular pain included Ocular Surface Disease Index (OSDI) > 13, minimal to no ocular surface fluorescein staining (less or equal to 1 on NEI scale), and presence of ocular pain.
IVCM images were exclusively collected from the corneal whorl, located in the inferonasal portion of the sub-basal nerve plexus. The images were automatically segmented by a deep learning algorithm trained on 207 manually segmented images from 69 eyes with ocular surface diseases (OSD). The algorithm labeled each pixel as pertaining to nerve, immune cell, neuroma, or background. Using the segmentation, we subsequently calculated the nerve density, average nerve thickness, nerve tortuosity, immune cell count, and neuroma count within an image frame (16000 μm2).

Results : The mean age of the subjects was 60 ± 12.5 (range 38 to 82 years), and 75% of them were female. 60 NOP eyes and 68 control eyes were imaged, yet focused corneal whorl images were obtained in 49 eyes and 48 eyes respectively.

The neuroma count was significantly higher in the NOP group as compared to the control group (2.23± 0.39 neuromas/frame vs 1.26 ± 0.20 neuromas/frame, P=0.03). Average nerve density was also significantly lower in the NOP group as compared to the controls (4616 μm ± 383.9 μm/frame vs 7832 μm ± 424.4 μm/frame, P=0.01).
Immune cell counts, nerve thickness and nerve tortuosity were not statistically different in the NOP group as compared to the control group (P=0.21, P=0.55, P=0.95, respectively)

Conclusions : Using IVCM corneal subbasal nerve plexus imaging with a standard landmark (the whorl) and deep learning- based automated segmentation, neuropathic ocular pain can be distinguished from controls on IVCM by an increased number of neuromas and lower average nerve density.
These findings validate similar observations in standard IVCM imaging and suggest that the corneal whorl can serve as a landmark biomarker for metric evaluation.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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