Early Optic Nerve Head Swelling Rate Is Associated with Worsening of Visual Outcomes in Nonarteritic Anterior Ischemic Optic Neuropathy
Abstract
Purpose: To characterize longitudinal OCT changes in nonarteritic anterior ischemic optic neuropathy (NAION) and to evaluate whether early rates of optic nerve head (ONH) swelling are associated with subsequent visual outcomes.
Design: Longitudinal cohort study based on a secondary analysis of data from the multicenter randomized QRK207 phase 2/3 NAION trial (ClinicalTrials.gov identifier, NCT02341560).
Participants: Seven hundred and fifteen participants with acute NAION were imaged within 14 days of symptom onset.
Methods: OCT imaging was performed at predefined visits using Cirrus or Spectralis devices. Structural measures included peripapillary retinal nerve fiber layer thickness (pRNFLT), peripapillary optic nerve head volume (pONHV), and macular ganglion cell-inner plexiform layer (mGCIPL) thickness. We analyzed rates of OCT metric change between screening (mean, 8.0 ±3.2 days from symptom onset) and enrollment (mean interval, 2.5 ±1.9 days). Associations between early OCT metrics and visual outcomes at month 6 were assessed using Spearman rank correlations (rs) and logistic regression.
Main outcome measures: Visual field (VF) total deviation and best-corrected visual acuity (BCVA), with worsening defined as 2-dB or more VF loss or 10-letter or more BCVA loss between enrollment and month 6.
Results: At presentation, study eyes showed pronounced ONH swelling (mean ± standard deviation: pRNFLT, 241 ±74.8 μm; pONHV, 6.70 ±1.27 mm3), followed by progressive atrophy (month…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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