Longitudinal assessment of macular structure-function and vasculature-function correlations across different stages...

Nonarteritic anterior ischemic optic neuropathy (NAION) is among the most common acute optic nerve disorders in individuals over 50 years old. Optical coherence tomography angiography (OCTA) has enabled the quantitative assessment of retinal structure and microcirculation, providing insights into the mechanisms underlying NAION. This study aimed to investigate the longitudinal structure-function (S-F) and vasculature-function (V-F) relationships in the macula across different stages of NAION.

This study examined 32 eyes from 32 patients with acute NAION. Optical coherence tomography (OCT) and OCTA were used to assess macular ganglion cell-inner plexiform layer (mGCIPL) thickness and macular vessel density (VD) at baseline, 1 month, and 3 months. Correlations between these structural and vascular parameters and visual outcomes, including best-corrected visual acuity (BCVA), visual field index (VFI), and mean deviation (MD), were analyzed.

Compared to the acute stage, the subacute phase exhibited significant reductions in mGCIPL thickness and macular VD. Significant global or regional correlations were found in S-F relationship only in subacute and chronic stage (P<0.05). In the acute stage, perifoveal VD of the superficial vascular plexus (SVP) in nasal section was correlated with the corresponding BCVA (r=-0.372; P=0.036), VFI (r=0.465; P=0.010), and MD (r=0.431; P=0.017) parameters. In the subacute and chronic stages, VD of SVP in most regions was significantly correlated with visual outcomes. None of the VDs in the deep vascular complex (DVC) were significantly correlated with visual outcomes.

Significant V-F correlations were present across all stages of NAION, while S-F correlations were observed only in subacute and chronic stage. Macular VD in the SVP, particularly in the nasal perifoveal region, may serve as an early indicator of visual function decline, highlighting its potential clinical value for monitoring disease progression and evaluating treatment strategies.