Clues to prognosis in anterior ischemic optic neuropathy: an optical coherence tomography angiography study

To investigate optic nerve vascularization in patients with anterior ischemic optic neuropathy (AION) during the first 3mo after onset, using comprehensive ophthalmic assessments combined with optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A).

A prospective longitudinal observational study was performed with a 3-month follow-up. Clinical data recorded included age, sex, laterality of ocular involvement, AION subtype, previous history of ischemic events, cardiovascular risk factors such as high blood pressure, dyslipidemia, diabetes mellitus, smoking status, obstructive sleep apnea, and systemic treatments received. Functional, structural, and vascular examinations, including best corrected visual acuity (BCVA), visual field, OCT, and OCT-A, were performed at baseline, 1, and 3mo.

Twenty-two subjects included 12 patients with AION and 10 healthy controls were enrolled. Mean age was 63.75±8.32y in the AION group and 61.80±5.04y in the control group (P=0.365). Gender and laterality distributions were comparable. AION patients showed significantly decreased optic nerve head perfusion at baseline (P=0.024) and 1mo (P=0.033). OCT revealed early thickening and subsequent atrophy of the peripapillary retinal nerve fiber layer and macular layers. OCT-A vascular parameters correlated significantly with 1-month BCVA (r=0.800, P≤0.05) and 3-month structural outcomes (r=0.807-0.835, P≤0.05).

Vascular parameters derived from OCT-A can act as predictive markers for medium-term visual and structural outcomes in patients with ischemic optic neuropathy.