Eye Examination Provides Clues to Diabetic Nerve Damage

Research in developing such a test was recently published by Nathan Efron, Ph.D., D.Sc., FAAO., and presented at a review of recent research on ophthalmic markers of diabetic peripheral neuropathy (DPN) with the goal of developing a quick, painless test to screen for diabetes-related nerve damage at routine eye care appointments.

In recent years, Dr. Efron has conducted extensive research into ways of detecting DPN by examining the eyes. The connection was made possible through “high-tech” techniques such as corneal confocal microscopy, which permits assessment of corneal nerve structure and function on the cellular level. Using this and other advanced techniques, Dr. Efron and his fellow researchers have discovered that diabetic neuropathy is linked to degradation of the corneal nerves, reduced corneal sensitivity, thinning of the retinal nerve fibers, and peripheral visual field loss.

The researchers hope to combine these four factors into a simple eye scan that can detect diabetic nerve damage in its early stages-even before the patient notices any symptoms. That’s important, because currently DPN can only be detected using painful nerve biopsies, or though indirect assessments like sensory testing.

The goal, according to Dr. Efron, is to develop a “rapid, painless, non-invasive, sensitive, reiterative, cost-effective, and clinically accessible means of screening for early detection, diagnosis, staging severity, and monitoring progression of DPN, as well as assessing the effectiveness of possible therapeutic interventions.”

A clinical trial, sponsored by the Juvenile Diabetes Research Foundation, is currently underway in Australia to evaluate the use of the simple eye scan for detection of DPN. If successful, the results will provide patients with diabetes and their physicians with an important new tool for early recognition and management of diabetes-related nerve damage. It may also pave the way to an expanded role for the eye care professions in diabetes screening, as well as monitoring the progression of DPN and the effects of clinical and treatment interventions.

Optometry and Vision Science