Reduced corneal nerve fiber density in type 2 diabetes by wide-area mosaic analysis

Research output: Contribution to journalArticle


PURPOSE. To determine if corneal subbasal nerve plexus (SBP) parameters derived from widearea depth-corrected mosaic images are associated with type 2 diabetes. METHODS. One hundred sixty-three mosaics were produced from eyes of 82 subjects by laserscanning in vivo confocal microscopy (IVCM). Subjects were of the same age, without (43 subjects) or with type 2 diabetes (39 subjects). Mosaic corneal nerve fiber length density (mCNFL) and apical whorl corneal nerve fiber length density (wCNFL) were quantified and related to the presence and duration of diabetes (short duration < 10 years and long duration ≥ 10 years). RESULTS. In mosaics with a mean size of 6 mm2 in subjects aged 69.1 ± 1.2 years, mCNFL in type 2 diabetes was reduced relative to nondiabetic subjects (13.1 ± 4.2 vs. 15.0 ± 3.2 mm/mm2, P = 0.018). Also reduced relative to nondiabetic subjects was mCNFL in both shortduration (14.0 ± 4.0 mm/mm2, 3.2 ± 3.9 years since diagnosis) and long-duration diabetes (12.7 ± 4.2 mm/mm2, 15.4 ± 4.2 years since diagnosis; ANOVA P = 0.023). Lower mCNFL was associated with presence of diabetes (P = 0.032) and increased hemoglobin A1c (HbA1c) levels (P = 0.047). By contrast, wCNFL was unaffected by diabetes or HbA1c (P > 0.05). Global SBP patterns revealed marked degeneration of secondary nerve fiber branches outside the whorl region in long-duration diabetes. CONCLUSIONS. Wide-area mosaic images provide reference values for mCNFL and wCNFL and reveal a progressive degeneration of the SBP with increasing duration of type 2 diabetes


  • Neil S. Lagali
  • Stephan Allgeier
  • Pedro Guimarães
  • Reza A. Badian
  • Alfredo Ruggeri
  • Bernd Köhler
  • Tor Paaske Utheim
  • Beatrice Peebo
  • Magnus Peterson
  • Lars B. Dahlin
  • Olov Rolandsson
External organisations
  • Linköping University
  • University of Padova
  • Oslo university hospital
  • Stavanger University Hospital
  • Uppsala University
  • Skåne University Hospital
  • Umeå University
  • Karlsruhe Institute of Technology
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Endocrinology and Diabetes


  • Confocal microscopy, Corneal nerves, Diabetes mellitus, Subbasal nerve
Original languageEnglish
Pages (from-to)6318-6327
Number of pages10
JournalInvestigative Ophthalmology and Visual Science
Issue number14
Publication statusPublished - 2017 Dec 1
Publication categoryResearch