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The correlation between corneal nerve tortuosity and pathology has been shown multiple times. However, because there isn't any defacto definition of tortuosity, reproducibility is poor. Indeed, many studies still rely on the manual observation and judgment of tortuosity. Recently, two distinct forms of corneal nerve tortuosity have been identified, describing either short-range or long-range directional changes. In this study we were able to develop automatic corneal nerve tortuosity measurements that correctly and independently represent these two tortuosity definitions. Furthermore, we show that a combination of mathematical tortuosity measurements improves on single metric results.

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