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Dry Eye SyndromesNCT05653921

Prospective Study to Validate the Imaging Biomarker for NCP (R33)

An observational study of Dry Eye Syndromes and Corneal Disease, run by Tufts Medical Center at 2 sites in United States.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

The aim of this study is establish the reliability and clinical utility of microneuromas as identified via in vivo confocal microscopy as the diagnostic biomarker for NCP. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Dry Eye Syndromes, Corneal Disease
What is being tested?
In vivo confocal microscopy (IVCM)
How many people
438 participants
Where
2 sitesUnited States
Study dates
16 Dec 2022to 31 Oct 2026
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: We will not be limiting the inclusion of the NCP or DED groups for this study. We will be recruiting from two Cornea Clinics in diverse large cities of Boston and Philadelphia. Thus, the sample collected from this group is expected to be representative of the population for each of these groups. We will be limiting inclusion of the control group to those age and sex matched controls as described above. This will allow for the conclusions drawn from this study to be more applicable in clinical practice. Without an age and sex matched control group, one could attribute differences in IVCM to these two variables instead of the disease(s).

Who may be able to join

  • All Subjects:
  • 18 years of age or older
  • Ability to consent
  • Best corrected visual acuity of 20/40 or better in each eye
  • Dry Eye Disease Group:
  • Chief complaint is ocular surface discomfort or dry eye disease, but subject reports no ocular pain on OPAS questionnaire
Show all 26Show fewer
  • Symptoms lasting at least 3 months
  • Presence of at least two of the following within the same eye:
  • Anesthetized Schirmer score =/< 10mm
  • Corneal staining of >3/15 based on NEI scale
  • Tear break up time < 10 seconds
  • Neuropathic Corneal Pain Group:
  • Chief complain is ocular surface discomfort or dry eye disease
  • Symptoms lasting at least 3 months
  • All of the following in both eyes:
  • Corneal staining of less than or equal to 3/15 based on NEI scale
  • Tear break up time =/> 10 seconds
  • Must have at least 25% peripheral pain
  • Subject reported discomfort prior to drop response testing of at least 3 out of 10
  • Control Group:
  • No symptoms of ocular surface discomfort or dry eye disease
  • All of the following in both eyes
  • Anesthetized Schirmer score > 10 mm
  • Corneal staining of less than or equal to 3/15 based on NEI scale
  • Tear break up time > 10 seconds
  • The same sex and within 5 years of age of a patient within the NCP group.

Who cannot join

  • Pregnant or nursing
  • Irregular corneal disease
  • Ocular surgery in the past 3 months
  • Ocular infection in the past 3 months
  • Active ocular allergies
  • Participation in a study that could potentially impact the IVCM in the opinion of the investigator
  • Current use of corneal nerve regeneration therapy that has been on-going for 3 months or more.
  • For NCP group only, patients for whom their pain and symptoms can be attributed to other causes in the opinion of the investigator

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Tufts Medical Center

    Boston, Massachusetts, 02111

  • Scheie Eye Institute, University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

Other trials in United States

About this study

Official title: Prospective Study to Validate the Imaging Biomarker for Neuropathic Corneal Pain.

The aim of this study is establish the reliability and clinical utility of microneuromas as identified via in vivo confocal microscopy as the diagnostic biomarker for NCP.

Read the detailed description

Dry Eye Disease (DED) is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities.

Neuropathic corneal pain (NCP), an ocular and severe type of neuropathic pain describes patients with symptoms of ocular discomfort out of proportion with clinical signs. The lack of clinical signs observed by standard ophthalmic examination has resulted in underdiagnosis of NCP or misdiagnosis as dry eye disease. Thus, having a biomarker for NCP is critical to identify and treat these patients. No biomarker or clinical signs exists to identify NCP patients.

Investigating corneal neurosensory abnormalities could help to diagnose NCP and potentially differentiate these patients from those with DED. In vivo confocal microscopy (IVCM) allows for real-time optical biopsies at a quasi-histological level, allowing for assessment of corneal nerves. IVCM non-invasive diagnostic imaging across NCP, DED, and healthy individuals will be analyzed to validate corneal microneuromas as a biomarker for NCP.

Being tested
In vivo confocal microscopy (IVCM)
Medical subject headings
Dry Eye Syndromes, Corneal Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • In vivo confocal microscopy (IVCM)Other

    In vivo confocal microscopy (IVCM) allows for visualization of the corneal structures at the cellular level, allowing for assessment of corneal nerves. With a magnification of 800 times, it makes it possible to detect and quantify changes in the epithelial layers and sub-basal nerve plexus.

Study groups in NCT05653921
Study groupRoleWhat they receive
Dry Eye Disease GroupSymptoms of ocular surface discomfort or dry eye disease for at least 3 months, supported by clinical exam findings. Reported quality of life is not effected by ocular pain.
Receives: Other: In vivo confocal microscopy (IVCM)
Neuropathic Corneal Pain GroupSymptoms of ocular surface discomfort or pain for at least 3 months, that are reported to have a significant impact on quality of life and ability to perform daily activities.
Receives: Other: In vivo confocal microscopy (IVCM)
Control GroupNo symptoms of ocular surface discomfort or dry eye disease.
Receives: Other: In vivo confocal microscopy (IVCM)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Presence of microneuromas as assessed by in vivo confocal microscopy (IVCM).

    The obtained sequence of IVCM imaging scans of both eyes will be evaluated for findings of microneuromas; defined as either observed presence or absence of microneuroma

    Measured: Day 1

Secondary outcomes (5)
  1. Intra-subject repeatability; Presence of the microneuroma biomarker in the same participant at 2 weeks

    Confirmation of presence of microneuroma on IVCM at 2 weeks in participants with IVCM finding of microneruoma at Visit 1

    Measured: From Day 1 to 2 weeks

  2. Establish the reference interval for the microneuroma biomarker

    Quantification of microneuromas as assessed by IVCM in each cohort (Normal vs. NCP vs. DED)

    Measured: Day 1

  3. Ocular Pain Assessment Survey (OPAS) questionnaire results correlation to microneuromas; OPAS reported quality of life score compared across the 3 cohorts.

    Ocular Pain Assessment Survey (OPAS) questionnaire: 27-item quantitative questionnaire designed to provide an assessment of the symptoms and quality of life effect of ocular pain. The 27 items of the OPAS questionnaire are graded on a scale of 0 to 10, or 10 to 100, where 0 indicates none and 10 or 100 indicate maximum. Higher scores indicate greater impact of ocular pain on quality of life dimensions.

    Measured: Day 1

  4. Hyperosmolar functional nerve tests in correlation to microneuromas; hyperosmolar functional nerve tests results compared cross cohorts

    Using the Pain Visual Analogue Scale (VAS), Symptoms of ocular comfort and dryness at the time in question will be graded for each eye verbally on a scale of 0-10, where 0=excellent comfort, no dryness and 10=extremely uncomfortable, extremely dry. A single drop of hypertonic sodium chloride solution (Muro 128®, 5%) at room temperature will be instilled into each eye. After 20 seconds, participants will be asked to grade their ocular comfort and dryness symptoms as described in the VAS procedure again allowing assessment of changes in sensation due to the hyperosmolar drop and activation of the polymodal nociceptors

    Measured: Day 1

  5. Test the utility of already configured AI software to diagnose NCP patients

    categorical variables of NCP and DED as diagnosed by the AI system and the classification of subjects into the NCP and DED groups based on inclusion criteria set by the study

    Measured: Day 1 to 2 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted16 Dec 2022
  2. Study start16 Dec 2022
  3. Primary completion31 Jul 2026 (estimated)
  4. Study completion31 Oct 2026 (estimated)

Why it stopped: PI si leaving institution. This study will likely be transferred to USF but study activity is not continuing at TMC.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
438 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05653921
Sponsor's protocol ID
STUDY00003018
Other IDs
4R33NS113341-02
Status last verified
Jan 2026
First submitted
6 Sep 2022
Last updated
7 Jan 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bujang MA, Adnan TH. Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. J Clin Diagn Res. 2016 Oct;10(10):YE01-YE06. doi: 10.7860/JCDR/2016/18129.8744. Epub 2016 Oct 1.

    PubMed 27891446
  • Ferrari G, Nallasamy N, Downs H, Dana R, Oaklander AL. Corneal innervation as a window to peripheral neuropathies. Exp Eye Res. 2013 Aug;113:148-50. doi: 10.1016/j.exer.2013.05.016. Epub 2013 Jun 14.

    PubMed 23769950
  • Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea. 2004 Nov;23(8):762-70. doi: 10.1097/01.ico.0000133997.07144.9e.

    PubMed 15502475
  • Sullivan BD, Crews LA, Messmer EM, Foulks GN, Nichols KK, Baenninger P, Geerling G, Figueiredo F, Lemp MA. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol. 2014 Mar;92(2):161-6. doi: 10.1111/aos.12012. Epub 2012 Dec 28.

    PubMed 23279964
  • Nichols KK, Bacharach J, Holland E, Kislan T, Shettle L, Lunacsek O, Lennert B, Burk C, Patel V. Impact of Dry Eye Disease on Work Productivity, and Patients' Satisfaction With Over-the-Counter Dry Eye Treatments. Invest Ophthalmol Vis Sci. 2016 Jun 1;57(7):2975-82. doi: 10.1167/iovs.16-19419.

    PubMed 27273596
  • Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, Broglio L, Granieri E, Lauria G. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. 2008 Jul;131(Pt 7):1912-25. doi: 10.1093/brain/awn093. Epub 2008 Jun 4.

    PubMed 18524793
  • Classification of Chronic Pain, Part III: Pain Terms, A Current List with Definitions and Notes on Usage. Second ed. Seattle: IASP Press; 1994

  • Dieckmann G, Koseoglu N, Moein HR, Kataguiri P, Hamrah P. Epidemiological factors of neuropathic corneal pain. IASP: The 18th World Congress on Pain; 2018; Boston, MA.

  • Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017 Jul;15(3):276-283. doi: 10.1016/j.jtos.2017.05.008. Epub 2017 Jul 20.

    PubMed 28736335
  • Yu J, Asche CV, Fairchild CJ. The economic burden of dry eye disease in the United States: a decision tree analysis. Cornea. 2011 Apr;30(4):379-87. doi: 10.1097/ICO.0b013e3181f7f363.

    PubMed 21045640
  • Lopez MJ, Jamali A, Dieckmann G, et al. Corneal Pain Has a Negative Impact on the Quality of Life of Patients with Neuropathic Corneal Pain. Investigative ophthalmology & visual science. 2018;59(9):138-138

  • Lopez MJ, Abbouda A, Pondelis N, et al. The Ocular Pain Assessment Survey and In Vivo Confocal Microscopy as Valuable Tools in the Diagnosis and Management of Patients with Corneal Neuropathic Pain. Investigative ophthalmology & visual science. 2017;58(8):1013-1013.

Questions about this trial

What is this clinical trial studying?

An observational study of Dry Eye Syndromes and Corneal Disease, run by Tufts Medical Center at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 26 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: paused, as of the sponsor's last update on 7 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Presence of microneuromas as assessed by in vivo confocal microscopy (IVCM). (time frame: Day 1). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05653921, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jan 2026.

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