The importance of nutritional status in NAION: risk assessment with PNI and CONUT scores

Nutritional and immune status are emerging as systemic factors that may influence the onset and course of optic nerve disorders. Recognising their potential role in neuro-ophthalmology can enhance preventive strategies and support holistic patient management in clinical practice.

Non-arteritic anterior ischaemic optic neuropathy (NAION) is a common cause of sudden, painless vision loss in older adults. Although vascular and systemic risk factors such as diabetes mellitus and hypertension are well-documented, emerging evidence suggests that nutritional and immune status may also play a role in its development.

A retrospective case-control study was conducted involving 50 NAION patients and 50 age-matched ophthalmologically healthy controls. The Prognostic Nutritional Index (PNI) was calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm³). Controlling Nutritional Status (CONUT) scores were derived from serum albumin, total cholesterol, and lymphocyte counts. Group differences were assessed using the Mann-Whitney U and Chi-square tests. Logistic regression identified independent predictors of NAION, with significance set at p < 0.05.

PNI values were significantly lower in NAION patients than in controls (42.32 ± 5.05 vs. 46.87 ± 1.95, p < 0.001), while CONUT scores were significantly higher (1.24 ± 1.62 vs. 0.22 ± 0.50, p < 0.001). Both PNI (OR = 0.657, 95% CI: 0.531-0.812, p < 0.001) and CONUT (OR = 3.102, 95% CI: 1.236-7.789, p = 0.009) independently predicted NAION. Diabetes mellitus and hypertension were also more prevalent in the NAION group (p < 0.05).

PNI and CONUT scores may serve as non-invasive, independent biomarkers for assessing NAION risk. These findings underscore the contribution of systemic nutritional and immune factors to NAION pathogenesis and support their integration into comprehensive patient evaluations. Prospective studies are needed to confirm these results and explore clinical applications.