Issue: March 2011
March 01, 2011
1 min read

Corneal confocal microscopy may aid in detecting diabetic neuropathy

Issue: March 2011
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Canadian Pediatric Endocrine Group

TORONTO — Corneal confocal microscopy can be employed as a proxy to detect diabetic neuropathy, an expert said here.

Corneal confocal microscopy represents an alternative to a skin biopsy and intraepidermal nerve fiber analysis, Bruce A. Perkins, MD, MPH, assistant professor and endocrinologist at University of Toronto/University Health Network, said during a presentation.

Perkins said corneal confocal microscopy is a fairly straightforward, noninvasive test for patients and could be translated to clinical practice so that patients may be screened for diabetic retinopathy and neuropathy by an eye specialist at the same visit.

“That value would then be communicated to the primary care provider or endocrinologist,” he said, noting that the test does not require new technology; rather, a retinal camera with a corneal module is used to adapt to the cornea.

Currently, Perkins said his team has used corneal confocal microscopy in 170 patients with diabetes and 60 patients without diabetes — without any corneal abrasions occurring.

“Corneal abrasion is a risk, but we have not run into any problems,” he said.

Previously published research using corneal confocal microscopy to diagnose and stratify diabetic neuropathy showed that corneal sensation decreased significantly with increasing neuropathic severity and was correlated with neuropathy disability score.

Improving the detection of diabetic retinopathy may help reduce the health burden associated with diabetic neuropathy, which is not insignificant, according to Perkins, who added that there is a need for an early diabetic neuropathy biomarker.

“We need to look for alternative ways to look at the morphology of nerves,” he said. “The cornea is an attractive target for looking at small fibers, in part because it has a lot of similarity to skin. If intraepidermal nerve fibers are important in the skin, they should mirror what is going on in the cornea.” – by Louise Gagnon

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Disclosure: Dr. Perkins receives funding from the Juvenile Diabetes Research Foundation, Canadian Institutes of Health Research, and the Banting and Best Diabetes Center.

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