Corneal nerve fractal dimension: a novel corneal nerve metric for the diagnosis of diabetic sensorimotor polyneuropathy

Chen, Xin; Graham, Jim; Petropoulos, Ioannis N.; Ponirakis, Georgios; Asghar, Omar; Alam, Uazman

Abstract

Objective: 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).

Methods: 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.

Results: 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.

Conclusions: ACNFrD shows comparable diagnostic efficiency to identify diabetic patients with and without DSPN.

Citation

Chen, X., Graham, J., Petropoulos, I. N., Ponirakis, G., Asghar, O., & Alam, U. (2018). Corneal nerve fractal dimension: a novel corneal nerve metric for the diagnosis of diabetic sensorimotor polyneuropathy. Investigative Ophthalmology & Visual Science, 59(2), https://doi.org/10.1167/iovs.17-23342

• Journal Article Type: Article
• Acceptance Date: Jan 21, 2018
• Publication Date: Feb 28, 2018
• Deposit Date: Mar 27, 2018
• Publicly Available Date: Mar 27, 2018
• Journal: Investigative Opthalmology & Visual Science
• Print ISSN: 0146-0404
• Electronic ISSN: 1552-5783
• Publisher: Association for Research in Vision and Ophthalmology
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Issue: 2
• DOI: https://doi.org/10.1167/iovs.17-23342
• Public URL: https://nottingham-repository.worktribe.com/output/916939
• Publisher URL: http://iovs.arvojournals.org/article.aspx?articleid=2673889
• Contract Date: Mar 27, 2018