title: Automated software analysis of corneal micrographs for peripheral neuropathy.
abstract: OBJECTIVE
  A relationship has been reported between the presence of peripheral neuropathy and the density and shape of corneal nerve fibers. Peripheral neuropathy is a debilitating condition that arises from many common health problems, and its presence is often confirmed with an invasive clinical test called intramuscular electromyography (EMG). In this study, the possibility of developing an alternative or adjunct test to EMG based on the appearance of nerve fibers in corneal micrographs was explored. Since corneal imaging is virtually noninvasive compared with EMG, such a test may be administered more liberally and frequently, before neuropathy symptoms occur.
  
  
  METHODS
  A software program that automatically traces nerve fibers in corneal micrographs and generates measures based on these traces was implemented. This software was applied to a database of images collected by confocal laser scanning corneal microscopy from diabetic subjects whose levels of neuropathy were measured with EMG and from healthy subjects.
  
  
  RESULTS
  Trends in the nerve fiber density and various measures of shape were calculated and observed, to explore the possibility of using these measures as a clinical tool for corroborating symptoms, confirming an evaluation, or evaluating risk factors for developing neuropathy.
  
  
  CONCLUSIONS
  Preliminary statistical trends show a potential for measuring and observing neuropathy severity or for providing an objective risk measure for a patient's ensuing condition. More work is needed in the development of the measures and in their testing to prove that the measures can be made repeatable in a clinical environment.
authors.affiliation: Lickenbrock Technologies, LLC, St. Louis, Missouri 63108, USA. tim.holmes@lickenbrocktech.com
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Holmes
authors.forename: Marco
authors.initials: M
authors.lastname: Pellegrini
authors.forename: Clayton
authors.initials: C
authors.lastname: Miller
authors.forename: Thomas
authors.initials: T
authors.lastname: Epplin-Zapf
authors.forename: Sean
authors.initials: S
authors.lastname: Larkin
authors.forename: Saverio
authors.initials: S
authors.lastname: Luccarelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Staurenghi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000294:innervation*; D004576:Electromyography; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D018613:Microscopy, Confocal / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D009412:Nerve Fibers / Q000473:pathology*; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000473:pathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D012984:Software; D012985:Software Design
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