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Optical coherence tomography (OCT) shows severe inner-retinal thinning in optic neuropathy. However, OCT has limited utility in predicting visual function, especially considering the cause of optic neuropathy.

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Medical Imaging

Background:

  • Optical coherence tomography (OCT) identifies severe inner-retinal thinning (RNFL/GCIPL below 1st percentile), typically indicating poor visual function.
  • Some patients exhibit preserved visual acuity despite significant OCT findings, highlighting a discrepancy between structure and function.

Purpose of the Study:

  • To correlate best-corrected visual acuity (BCVA) with OCT parameters in optic neuropathy patients with extreme RNFL/GCIPL thinning.
  • To determine the limitations of OCT in predicting visual function in these patients.
  • To explore how different optic neuropathy etiologies impact the structure-function relationship.

Main Methods:

  • Retrospective analysis of 131 optic neuropathy patients with OCT-detected severe inner-retinal thinning.
  • Correlation analysis between BCVA (logMAR) and various OCT parameters (RNFL, GCIPL).
  • Comparison of BCVA and OCT findings across different optic neuropathy etiologies (e.g., LHON, ON, MOGAD).

Main Results:

  • Mean BCVA was 0.55 ± 0.70 logMAR, with significant variability.
  • Temporal GCIPL (r=-0.412) and average GCIPL (r=-0.366) showed the strongest correlations with BCVA.
  • Lower BCVA was observed in Leber hereditary optic neuropathy (LHON) compared to other etiologies.
  • Idiopathic optic neuritis (ON) and MOGAD patients had better and more consistent BCVA outcomes.

Conclusions:

  • OCT has limited utility in reflecting BCVA in optic neuropathy, even with significant inner-retinal thinning.
  • Caution is advised when interpreting OCT findings, particularly in relation to visual function and specific optic neuropathy causes.
  • The etiology of optic neuropathy influences the relationship between retinal structure and visual function.