Vision transformers for automated detection of diabetic peripheral neuropathy in corneal confocal microscopy images

Early detection and management of diabetic peripheral neuropathy (DPN) are critical to reducing associated morbidity and mortality. Corneal Confocal Microscopy (CCM) facilitates the imaging of corneal nerves to detect early and progressive nerve damage in DPN. However, its wider adoption has been limited by the subjectivity and time-intensive nature of manual nerve fiber quantification. This study investigates the diagnostic utility of state-of-the-art Vision Transformer (ViT) models for the binary classification of CCM images to distinguish between healthy controls and individuals with DPN. The ViT model's performance was also compared to ResNet50, a convolutional neural network (CNN) previously applied for DPN detection using CCM images. Using a dataset of approximately 700 CCM images, the ViT model achieved an AUC of 0.99, a sensitivity of 98%, a specificity of 92%, and an F1-score of 95%, outperforming previously reported methods. These findings highlight the potential of the ViT model as a reliable tool for CCM-based DPN diagnosis, eliminating the need for time-consuming manual image segmentation. Moreover, the results reinforce CCM's value as a non-invasive and precise imaging modality for detecting nerve damage, particularly in neuropathy-related conditions such as DPN.