Structure-function correlates in anterior visual pathway lesions: a systematic review

Visual field defects allow for the localisation of pathologic aetiologies along the entire visual system. However, various aetiologies and location of damage might lead to field defect at similar areas. We reviewed the literature systematically for cases of optic neuropathy with well-defined lesions along the anterior visual pathway from the retina to the lateral geniculate with the goal of correlating specific visual field manifestations with the underlying pathology at each segment. We searched MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science databases on June 9, 2024. We included studies reporting damage at any segment of the anterior visual pathway with corresponding VF outcomes. Studies without primary data or new analyses were excluded. We also provided detailed figures from our own practice of cases with specific anterior visual pathway lesions at different locations and their respective visual field manifestations. Pathologies affecting the retinal ganglion cells and optic disc showed strong correlations with specific visual field defects such as arcuate or altitudinal patterns, and exhibited characteristic structural changes. More posterior lesions commonly produced visual field defects related to crossing fibres. These lesions were also associated with distinctive structural indicators. We emphasise the clinical importance of recognising both anterograde (from the retina) and retrograde (from the lateral geniculate body) axonal degeneration in the development of secondary optic atrophy. This review represents a guide for physicians in their assessment when evaluating visual field defects secondary to optic neuropathy.