We thank Patel and McGhee for their comments. We agree that the results of an assessment of corneal nerve changes by in vitro confocal microscopy (IVCM) should be interpreted with caution. This new approach definitely still requires validation in larger cohorts of patients and the establishment of specific criteria allowing accurate qualification and quantification of corneal nerve alterations. In this regard, the recent publication by Visser et al1 will certainly help to better delineate both the usefulness and the limitations of corneal IVCM.
Lalive PH, Dosso A. In Vivo Confocal Microscopy of Corneal Stromal Nerves in Patients With Peripheral Neuropathy—Reply. Arch Neurol. 2009;66(9):1179-1180. doi:10.1001/archneurol.2009.192