Abstract
Purpose :
Neuropathic corneal pain presents a challenging clinical scenario with limited consensus on its management. This study aimed to gather insights into the causes, investigative approaches, and management strategies for neuropathic corneal pain (NCP) among corneal specialists globally.
Methods :
We conducted a survey comprising 32 questions, including demographic, causes, investigations, treatments, and multidisciplinary engagement questions. A total of 52 responses (34%) were collected from the 152 invited international experts. We explored descriptive statistics as well as the influence of responder characteristics on the answers provided (Wilcoxon rank-sum test).
Results :
The survey revealed that chronic ocular surface disease (n=42; 41%) and post-surgical factors (n=33; 34%) were the most commonly reported causes of neuropathic corneal pain. The 3 most common investigations were the Proparacaine challenge test, Schirmer’s test, and corneal esthesiometry with the majority of respondents stating they always perform these (Figure 1). In Vivo Confocal Microscopy (IVCM) was used routinely by 37% (n=19) of clinicians. 69% (n=29) of respondents who use IVCM stated that an abnormal IVCM influenced their management. Ocular pain questionnaires were utilised by 69% (n=36) of respondents, with the Ocular Surface Disease Index (OSDI) being the most used questionnaire (n=26; 31%). The treatments most frequently used included artificial tears (n=48; 94%), serum/plasma-derived tears (n=41; 80%),topical corticosteroids (n=34; 67%), and topical cyclosporin (n=30; 59%) (Figure 2). Notably, only 38% (n=19) of corneal specialists were comfortable independently prescribing systemic pharmacotherapy. The multidisciplinary approach was embraced by 46% (n=24) of respondents, with pain management (n=31; 38%) and neurology (n=26, 32%) specialists being the most commonly involved.
Conclusions :
This survey provides valuable insights into the causes, investigations, and management of NCP according to the perspectives of corneal specialists globally. These findings offer a basis for further research and the development of guidelines to address the unmet needs of this challenging condition effectively.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.