Visual prognosis in eyes with no light perception vision at nadir: A systematic review and meta-Analysis

No light perception (NLP) vision is the most severe measurable level of visual loss. Recovery is widely understood to be possible in some settings, but its probability has never been quantified across etiologies. Following PRISMA 2020 and MOOSE guidelines (PROSPERO: CRD420261337887), we searched four databases from inception to March 11, 2026. The search captured a broad, prespecified range of ocular etiologies, but only open globe injury (OGI), traumatic optic neuropathy (TON), and autoimmune optic neuritis yielded NLP-specific subgroups large enough to pool. Of 37 included studies, 24 (1,339 eyes) entered quantitative synthesis. Pooled recovery to light perception or better was 43.3% (95% CI: 33.8-53.1%), with considerable heterogeneity (I² = 89.8%); recovery was strongly etiology-dependent: autoimmune optic neuritis 92.1%, TON 44.6%, OGI 37.4%. Recovery to ≥20/200 occurred in 12.1% of eyes and to ≥20/40 in 1.5%. Certainty of evidence was very low. NLP is therefore not a single prognostic entity: the probability of recovery differs roughly two- to threefold by etiology, while recovery of functional acuity remains uncommon irrespective of cause. Prognosis should be framed by mechanism rather than by acuity alone.