Abstract
PurposeInvestigate the correlation and agreement between the results of semiautomated and fully automated quantitative analysis of the corneal sub-basal nerve plexus (SNP) in patients with dry eye disease (DED) with ocular pain using in vivo confocal microscopy (IVCM).MethodA total of 50 voluntary participants were enrolled in this study, i.e., 25 DED patients with ocular pain and 25 healthy controls. Each patient underwent an evaluation of ocular symptoms that utilized: the Ocular Surface Disease Index (OSDI), the Ocular Pain Assessment Survey (OPAS), the tear film breakup time (TBUT) test, the Schirmer test, corneal staining, and IVCM. Five SNP images of the cornea of each eye were selected and analyzed using a semiautomated analysis software (NeuronJ) and a fully automated method (ACCMetrics) to quantify corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL).ResultsThe intraclass correlation coefficient (ICC) of the CNFD (0.460 [0.382–0.532], p < 0.001), CNBD (0.608 [0.545–0.665], p < 0.001), and CNFL (0.851 [0.822–0.875], p < 0.001) represents the repeatability and consistency of measurements by the NeuronJ and ACCMetrics software. The CNFL values (r = 0.881, p < 0.001) obtained using the two methods have extremely high correlation, and similarly, the CNFD values (r = 0.669, p < 0.001) and CNBD values (r = 0.703, p < 0.001) are highly correlated. The CNFL had the biggest area under the curve (AUC; 0.747 [0.700–0.793], p < 0.001) when using ACCMetrics. In DED patients with ocular pain, the mean CNFD values for semiautomated and fully automated quantization were 23.5 ± 8.1 and 23.8 ± 8.6 n/mm2; the mean CNBD values were 46.0 ± 21.3, 35.7 ± 23.3 n/mm2; and the mean CNFL values were 19.3 ± 4.3 and 15.2 ± 3.8 mm/mm2, which were significantly lower than healthy subjects (p < 0.001).ConclusionThere is a significant correlation between the measurements obtained via ACCMetrics and NeuronJ, especially for CNFL, which can be considered as the primary indicator in the diagnosis of DED with ocular pain. The SNP of the disease was significantly lower than that of healthy subjects.
Highlights
Dry eye disease (DED) is one of the most often reported ocular diseases, with a global incidence of 5–50% by symptoms [1,2,3]
It is commonly accepted that DED combined with ocular pain alters the structure and function of the ocular surface’s sensory nerves, resulting in the appearance of unpleasant sensations ranging from mild discomfort and dryness to scorching pain [5]
The objective of this study is to evaluate the diagnostic performance of ACCMetrics, a fully automated software, with that of NeuronJ, a semiautomated program, in distinguishing patients with DED with ocular pain from healthy controls via in vivo confocal microscopy (IVCM) morphometric analysis of the corneal sub-basal nerve plexus (SNP)
Summary
Dry eye disease (DED) is one of the most often reported ocular diseases, with a global incidence of 5–50% by symptoms [1,2,3]. Along with abnormalities of the tear film and ocular surface, the revised DED criteria include neurosensory dysfunction as a contributing component. Ocular pain, such as burning, aching, and itching, is a frequent symptom of moderate-to-severe DED. Nerve fibers in the human cornea flow radially from the periphery of the anterior part of the stroma to its center. These nerve fibers penetrate the Bowman’s layer and branch vertically and horizontally between the epithelium of the Bowman’s layer and the basal epithelium to create a network of nerve fibers known as the sub-basal nerve plexus (SNP) [6]. Numerous scientific investigations have been conducted on the corneal nerve’s structural and functional anomalies in the setting of a range of ocular and systemic illnesses [7]
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