{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:46:30Z","timestamp":1791557190472,"version":"4.3.4"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1DP3DK104386-01"],"award-info":[{"award-number":["1DP3DK104386-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["8-2008-362"],"award-info":[{"award-number":["8-2008-362"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008664","name":"Juvenile Diabetes Research Foundation","doi-asserted-by":"publisher","award":["1DP3DK104386-01"],"award-info":[{"award-number":["1DP3DK104386-01"]}],"id":[{"id":"10.13039\/100008664","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008664","name":"Juvenile Diabetes Research Foundation","doi-asserted-by":"publisher","award":["8-2008-362"],"award-info":[{"award-number":["8-2008-362"]}],"id":[{"id":"10.13039\/100008664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Diabetic peripheral neuropathy (DPN) is the leading cause of neuropathy worldwide resulting in excess morbidity and mortality. We aimed to develop an artificial intelligence deep learning algorithm to classify the presence or absence of peripheral neuropathy (PN) in participants with diabetes or pre-diabetes using corneal confocal microscopy (CCM) images of the sub-basal nerve plexus. A modified ResNet-50 model was trained to perform the binary classification of PN (PN+) versus no PN (PN\u2212) based on the Toronto consensus criteria. A dataset of 279 participants (149 PN\u2212, 130 PN+) was used to train (n = 200), validate (n = 18), and test (n = 61) the algorithm, utilizing one image per participant. The dataset consisted of participants with type 1 diabetes (n = 88), type 2 diabetes (n = 141), and pre-diabetes (n = 50). The algorithm was evaluated using diagnostic performance metrics and attribution-based methods (gradient-weighted class activation mapping (Grad-CAM) and Guided Grad-CAM). In detecting PN+, the AI-based DLA achieved a sensitivity of 0.91 (95%CI: 0.79\u20131.0), a specificity of 0.93 (95%CI: 0.83\u20131.0), and an area under the curve (AUC) of 0.95 (95%CI: 0.83\u20130.99). Our deep learning algorithm demonstrates excellent results for the diagnosis of PN using CCM. A large-scale prospective real-world study is required to validate its diagnostic efficacy prior to implementation in screening and diagnostic programmes.<\/jats:p>","DOI":"10.3390\/jcm12041284","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T04:59:10Z","timestamp":1675659550000},"page":"1284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Artificial Intelligence Based Analysis of Corneal Confocal Microscopy Images for Diagnosing Peripheral Neuropathy: A Binary Classification Model"],"prefix":"10.3390","volume":"12","author":[{"given":"Yanda","family":"Meng","sequence":"first","affiliation":[{"name":"Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3953-331X","authenticated-orcid":false,"given":"Frank George","family":"Preston","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Ferdousi","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University of Manchester, Manchester M13 9PL, UK"},{"name":"Manchester Diabetes Centre, Manchester Foundation Trust, Manchester M13 0JE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shazli","family":"Azmi","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University of Manchester, Manchester M13 9PL, UK"},{"name":"Manchester Diabetes Centre, Manchester Foundation Trust, Manchester M13 0JE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis Nikolaos","family":"Petropoulos","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0390-0592","authenticated-orcid":false,"given":"Stephen","family":"Kaye","sequence":"additional","affiliation":[{"name":"Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK"},{"name":"St Paul\u2019s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7188-8903","authenticated-orcid":false,"given":"Rayaz Ahmed","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine-Qatar, Doha 24144, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3190-1122","authenticated-orcid":false,"given":"Uazman","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK"},{"name":"St Paul\u2019s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK"},{"name":"Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK"},{"name":"St Paul\u2019s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK"},{"name":"Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.clinthera.2018.04.001","article-title":"Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy","volume":"40","author":"Iqbal","year":"2018","journal-title":"Clin. 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