Association of corneal nerve parameters with nerve abnormalities and neuropathic pain in prediabetes and type 2 diabetes: the Maastricht Study – published online 10/02/2026

Mette K. Borbjerg, Sara Mokhtar, Nadia Sutedja, Annemarie Koster, Carsten D. Mørch, Tos T. J. M. Berendschot, Nicolaas Schaper, Niels Ejskjaer, Johan Røikjer

Diabetic polyneuropathy is a common complication of diabetes, and early detection remains essential for timely intervention. There is a need for reliable, scalable methods to detect early nerve damage in clinical settings. Corneal confocal microscopy has emerged as a non-invasive technique to assess small nerve fibre structure but typically involves time-consuming image selection and manual analysis. In this issue, Borbjerg et al (https://doi.org/10.1007/s00125-026-06676-8) use wide-field corneal confocal microscopy combined with fully automated nerve tracing to examine associations between corneal nerve parameters, electrophysiological abnormalities and neuropathic pain in 3425 participants from the population-based Maastricht Study. The authors show that these measures are associated with electrophysiological markers of axonal degeneration, supporting their validity as indicators of structural nerve damage. However, no associations were observed with neuropathic pain. The authors conclude that these findings support the potential of wide-field, automated corneal imaging for large-scale neuropathy assessment, while highlighting the need for other methods to evaluate neuropathic pain.