VIDEO: Early diagnosis represents ‘significant’ challenge in neurotrophic keratitis

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That’s a great question because it doesn’t matter how good of tools we have clinically; if we can’t pick up the disease until it’s too late, that presents as a challenge. And I would say the clinical challenge here is relatively straightforward, but still a significant one and that is currently the recognized gold standard diagnostic test for NK is corneal sensitivity.

Whether you want to do that by Cochet-Bonnet quantitatively, so you could have a filament length to denote the severity of the disease or something more qualitatively, like a wisp of your cotton swap. This gold standard corneal sensitivity test is not part of the required portion of a regular eye exam. That means, very much like other degenerative eye diseases, like say keratoconus — many of you know that I’m very interested in managing keratoconus patients as well — but very similar to any such disease that’s degenerative, if we don’t actively look and screen for early stage of the disease so that we can deliver maximal impact for more desirable, long-term prognosis, then we’re basically just sitting back and waiting for a more severe stage to present itself.

Either vision is severely impaired, because of ulcer or scarring or epithelial changes, when a patient comes to us they may not know that there’s a problem until something very severe happens. But by then the disease severity is so late-stage that it becomes much, much harder to treat and more difficult to obtain positive management outcomes. In my mind, that’s the challenge.