Understanding Patterns of Luxury Perfusion on Optical Coherence Tomography Angiography: A Novel Insight

A 60-year-old male patient came to the outpatient department with the complaint of gradual, painless, progressive diminishing of vision in right eye for two months. His medical history included diabetes mellitus type II, hypertension, and hypercholesterolaemia for eight years. Best corrected visual acuity on snellen's chart for distance was 6/9 in right eye and 6/6 in left eye and for near was N6 in both eyes. Colour vision was intact bilaterally and there was no relative afferent pupillary defect. Anterior segments findings were within normal limits. Fundus examination revealed superior disc pallor and inferiorly showed hyperaemia with dilated vessels. Humphrey visual field testing showed incomplete inferonasal field loss in the right eye which correlated with the disc findings of superior disc pallor. OCT-A showed various pattern changes in the retinal peripapillary capillaries like capillary dropout areas in the temporal region, increase in the vessel density in non-ischaemic areas depicting luxury perfusion, dilatation, and tortuosity of small and large vessels with loss of their radial pattern. Here we describe a unique case where optical coherence tomography angiography (OCT-A) was a helpful investigation in diagnosing luxury perfusion in a patient of Non Arteritic anterior ischaemic optic neuropathy (NAION).