Central and peripheral regional variation of corneal nerve fibre parameters
In brief
Corneal nerve measurements differ by region, with the inferior whorl showing the most branching
In 40 healthy volunteers, corneal nerve length, branch density and fibre density varied significantly across six imaging regions. The inferior whorl had the greatest nerve length and branching, while fibre density was highest centrally; even small shifts in imaging location can change measurements. Standardised targeting is important, but how these regional differences affect assessments in people with disease remains unknown.
- Journal
- Clinical & experimental optometry (Q2)
- Published
- 1 November 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Vennela Vankudoth, Maria Markoulli, Nagaraju Konda
- PMID
- 42967401
- DOI
- 10.1080/08164622.2026.2722997
Why clinicians should know about it
- Picked for Histology (top studies of the week, 8 November 2026): Quantifies regional normal corneal nerve architecture by confocal microscopy
Abstract
CLINICAL RELEVANCE: Regional variation in corneal nerve morphology may affect the interpretation of corneal confocal microscopy findings in clinical practice. Precise anatomical localisation is important when assessing corneal nerve health. BACKGROUND: Corneal confocal microscopy is increasingly used to quantify corneal nerve morphology in health and disease. However, regional differences in corneal nerve parameters across the cornea have not been fully characterised, and variation in imaging location may influence measured parameters. METHODS: Corneal nerves of 40 healthy volunteers were imaged in six regions using Heidelberg Retinal Tomograph III with the Rostock module (Heidelberg Engineering, Germany). Images were obtained from the central, inferior whorl, inferior, nasal, superior and temporal regions. Corneal nerve fibre length, branch density and fibre density were analysed using automated software developed at the University of Manchester, United Kingdom. RESULTS: The mean age of participants was 26.3 ± 3.7 years. Significant regional differences were observed in corneal nerve fibre length (p < 0.001), branch density (p < 0.001) and fibre density (p = 0.002). Fibre length in the inferior whorl was significantly higher than in the inferior (p = 0.002), nasal (p = 0.001) and temporal (p < 0.001) regions. Branch density was highest in the inferior whorl and exceeded all other regions (all p ≤ 0.001). Central fibre density was significantly higher than inferior fibre density (p = 0.02). CONCLUSION: Significant regional variability exists in corneal nerve parameters. The central cornea exhibits the highest fibre density, whereas the inferior whorl demonstrates the greatest fibre length and branch density and serves as a distinct anatomical landmark. Subtle shifts in imaging location may produce markedly different measurements, highlighting the importance of standardised anatomical targeting.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.