Neurotrophic Keratopathy Visual Acuity Outcomes Worse With Diabetes, History of Ocular Disease

Close-up of an eye with dendritic keratitis, showing branch-shaped corneal lesions caused by herpes simplex infection.
01APAM7A – Close-up of an eye with dendritic keratitis, showing branch-shaped corneal lesions caused by herpes simplex infection. Keratitis is the inflammation of the cornea of the eye.
Patients with neurotrophic keratopathy who have a history of diabetes, herpetic keratitis, or have undergone corneal transplantation have worse visual acuity.

Neurotrophic keratopathy (NK) has a prevalence of 21.34 cases per 100,000 patients (0.021%) in the United States, according to research published in Ophthalmology. The investigation also shows worse visual acuities in patients with NK are tied to several demographic characteristics, including a history of diabetes, corneal transplant, and herpetic keratitis.

Researchers conducted a retrospective study to describe the characteristics of NK in the US. They used the American Academy of Ophthalmology IRIS® (Intelligent Research in Sight) Registry to identify and analyze visits associated with a diagnosis of NK between 2013 and 2018. In addition to estimating NK prevalence, the team also evaluated demographic characteristics, concomitant diagnoses and procedure codes, and risk factors impacting visual acuity (VA) after NK onset.

Data from a total of 31,915 eyes from 27,483 patients (59% women) with a diagnosis of NK were included in the analysis. Patients’ mean age at diagnosis of NK was 68.0±16.0 years. NK presentation was unilateral in 58.14% of patients and bilateral in 16.13% of patients (unspecified in 25.73%). 

The researchers estimated that the average 6-year prevalence of NK was 21.34 cases per 100 000 patients (0.021%), and the mean logMAR VA was significantly worse after (0.88±0.94) vs prior to NK diagnosis (0.60 ± 0.79; P <.0001).  

They found the most common concomitant diagnoses were herpetic keratitis (33.70%), diabetes (31.59%), and corneal dystrophy (14.28%) and the most common procedures for NK management were the use of amniotic membrane (29.90%), punctal plugs (29.65%), and bandage contact lenses (22.67%). 

Using a multivariate analysis, the team demonstrated that age, male sex, Black race, Hispanic or Latino ethnicity, unilateral involvement, concomitant diagnoses of diabetes, corneal transplant, or herpetic keratitis were significantly associated with worse VA.

“This is the largest available epidemiological study of NK, and our findings further the understanding of the burden and characteristics of NK in the US,” according to the researchers.

Limitations of the study included the retrospective design, possible coding errors and missing data in the database, and a high percentage of patients without recorded laterality of NK.


Bian Y, Ma KK, Hall NE, et al. Neurotrophic keratopathy in the United States: an IRIS® registry (Intelligent Research in Sight) analysis. Ophthalmol. Published online June 26, 2022. doi:10.1016/j.ophtha.2022.06.019