title: Fully automated, semiautomated, and manual morphometric analysis of corneal subbasal nerve plexus in individuals with and without diabetes.
abstract: OBJECTIVE
  The aim of the study was to determine the association, agreement, and detection capability of manual, semiautomated, and fully automated methods of corneal nerve fiber length (CNFL) quantification of the human corneal subbasal nerve plexus (SNP).
  
  
  METHODS
  Thirty-three participants with diabetes and 17 healthy controls underwent laser scanning corneal confocal microscopy. Eight central images of the SNP were selected for each participant and analyzed using manual (CCMetrics), semiautomated (NeuronJ), and fully automated (ACCMetrics) software to quantify the CNFL.
  
  
  RESULTS
  For the entire cohort, mean CNFL values quantified by CCMetrics, NeuronJ, and ACCMetrics were 17.4 ± 4.3 mm/mm, 16.0 ± 3.9 mm/mm, and 16.5 ± 3.6 mm/mm, respectively (P < 0.01). CNFL quantified using CCMetrics was significantly higher than those obtained by NeuronJ and ACCMetrics (P < 0.05). The 3 methods were highly correlated (correlation coefficients 0.87-0.98, P < 0.01). The intraclass correlation coefficients were 0.87 for ACCMetrics versus NeuronJ and 0.86 for ACCMetrics versus CCMetrics. Bland-Altman plots showed good agreement between the manual, semiautomated, and fully automated analyses of CNFL. A small underestimation of CNFL was observed using ACCMetrics with increasing the amount of nerve tissue. All 3 methods were able to detect CNFL depletion in diabetic participants (P < 0.05) and in those with peripheral neuropathy as defined by the Toronto criteria, compared with healthy controls (P < 0.05).
  
  
  CONCLUSIONS
  Automated quantification of CNFL provides comparable neuropathy detection ability to manual and semiautomated methods. Because of its speed, objectivity, and consistency, fully automated analysis of CNFL might be advantageous in studies of diabetic neuropathy.
authors.affiliation: *Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; †Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia; ‡School of Medicine, University of Queensland, Brisbane, Australia; and §Center for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom.
authors.forename: Cirous
authors.initials: C
authors.lastname: Dehghani
authors.forename: Nicola
authors.initials: N
authors.lastname: Pritchard
authors.forename: Katie
authors.initials: K
authors.lastname: Edwards
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Russell
authors.forename: Rayaz A
authors.initials: RA
authors.lastname: Malik
authors.forename: Nathan
authors.initials: N
authors.lastname: Efron
mesh_terms: D003315:Cornea / Q000294:innervation*; D003389:Cranial Nerve Diseases / Q000175:diagnosis*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D003929:Diabetic Neuropathies / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D018613:Microscopy, Confocal; D008875:Middle Aged; D009412:Nerve Fibers; D009882:Ophthalmic Nerve / Q000473:pathology*