Diagnostic Accuracy of Paracentral Acute Middle Maculopathy for Arteritic Anterior Ischemic Optic Neuropathy
Related Experiment Video
Updated: Oct 31, 2026
Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential
Published on: May 25, 2020
Sanjana Molleti1, Mary V Lang2, Babajide Owosela3
1Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Purpose:
The purpose of this study was to evaluate the diagnostic accuracy of paracentral acute middle maculopathy (PAMM) detected on optical coherence tomography (OCT) macula for differentiating arteritic anterior ischemic neuropathy (AAION) from nonarteritic anterior ischemic optic neuropathy (NAION) in a multicenter United States cohort.
Design:
Retrospective, multicenter diagnostic accuracy analysis.
Participants:
This study included patients diagnosed with AAION or NAION at the University of Minnesota, Mayo Clinic, and Johns Hopkins Wilmer Eye Institute between January 2020 and January 2025. Inclusion criteria consisted of patients older than 50 years who had obtained OCT macula within 14 days of symptom onset. AAION diagnoses were confirmed by temporal artery biopsy or positron emission tomography/computed tomography.
Methods:
Two masked fellowship-trained neuro-ophthalmologists independently evaluated OCT images for the presence of acute PAMM.
Main Outcome Measures:
Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAMM for AAION were calculated.
Results:
A total of 119 patients were included, consisting of 27 patients with AAION and 92 patients with NAION. PAMM was identified in 18.5% of patients with AAION and 5.4% of patients with NAION (p = 0.032). The sensitivity, specificity, PPV, and NPV of PAMM for AAION was 19% [95% CI: 0.08-0.37], 94.6% [95% CI: 0.88-0.98], 50% [95% CI: 0.24-0.76], and79.8% [95% CI: 0.71-0.86] respectively. Three of five NAION patients with PAMM had provoked NAION associated with severe systemic hypoperfusion.
Conclusion:
PAMM is a highly specific but insensitive OCT marker for AAION. Although its presence should increase clinical suspicion for AAION, PAMM may rarely occur in patients with NAION particularly in the setting of systemic hypoperfusion and should be interpreted within the overall clinical context.
