This article was originally published in a sponsored newsletter.
We are hearing more and more about neurotrophic keratitis and how the loss of corneal nerves—and, by extension, corneal sensation—can lead to the cornea’s inability to support the integrity of the epithelium, progressive deterioration of the trophic supply to the nerves and improper healing. Ultimately, these effects can lead to persistent epithelial defects and possibly neurotrophic ulcers. The underlying causes of neurotrophic keratitis can be rapid in cases of corneal injury or infection, or slow with a series of gradual stressing co-morbidities such as diabetes, corneal refractive surgery, nocturnal desiccative stress due to inadequate lid seal (ILS) or years of contact lens wear. We currently only test for corneal sensitivity when there is damage to the cornea that will not resolve with conventional treatment. We also consider a neurotropic cause for delayed or recalcitrant healing when the co-morbidities stack up. At that point however, the damage has begun and the cornea has been compromised.
What if we could progressively measure the effect of stress on the cornea and access corneal nerve health under other scenarios that we acknowledge can have a negative effect on the nerves in the body, such as diabetes or other systemic disease? And what about your contact lens wearers? If we were able to measure corneal nerve health regularly and see a progressive loss of sensation, we could be proactive with attempting to generate those nerves. Imagine that we could run yearly routine monitoring of corneal nerve health. We might be able to prognosticate the ability for those patients to successfully continue to wear contact lenes and possibly intervene with procedures, medications or both to try and regenerate nerves to increase their density and sensitivity. What if, rather than being reactive, we could be proactive just by monitoring corneal nerve health?
I believe that we are headed for a change where we can prognosticate and intervene by routinely measuring any patient’s corneal nerve health if they have risk factors, co-morbidities or both that can lead to a deterioration of corneal health. We might even see the progression of dry eye disease before the breakdown of the epithelium and proactively intervene.
Brill Engines, part of Brill International and a multinational pharmaceutical company, has developed a non-contact portable corneal esthesiometer that can rapidly and reproducibly measure and quantify corneal sensitivity in a clinic. This device is suited for a general eye care clinic and not just a research facility. It can accurately measure both hyper- and hypo- corneal nerve responses. Devices such as this one will enable us to provide proactive care that can be performed in general eye care clinic through routinely monitoring corneal sensitivity.
