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Early Optic Nerve Head Swelling Rate is Associated with Worsening of Visual Outcomes in Nonarteritic Anterior Ischemic Optic Neuropathy
Journal article   Open access   Peer reviewed

Early Optic Nerve Head Swelling Rate is Associated with Worsening of Visual Outcomes in Nonarteritic Anterior Ischemic Optic Neuropathy

Brian Woods, David Szanto, Jui-Kai Wang, Asala Erekat, Aaron Golden, Mona K Garvin, Zoe R Williams, Edward F Linton, Randy H Kardon and Mark J Kupersmith
Ophthalmology (Rochester, Minn.)
05/18/2026
DOI: 10.1016/j.ophtha.2026.05.013
PMID: 42155674
url
https://doi.org/10.1016/j.ophtha.2026.05.013View
Published (Version of record) Open Access

Abstract

To characterize longitudinal optical coherence tomography (OCT) changes in nonarteritic anterior ischemic optic neuropathy (NAION) and evaluate whether early rates of optic nerve head (ONH) swelling are associated with subsequent visual outcomes. Longitudinal cohort study based on a secondary analysis of data from the multicenter randomized QRK207 phase 2/3 NAION trial (NCT02341560). 715 participants with acute NAION were included. Study eyes were imaged within 14 days of symptom onset. 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 thickness (mGCIPL). 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 (r ) and logistic regression. Visual field (VF) total deviation and best-corrected visual acuity (BCVA), with worsening defined as ≥2 dB VF loss or ≥10-letter BCVA loss between Enrollment and Month 6. At presentation, study eyes showed pronounced ONH swelling (mean pRNFLT, 241 ±74.8 μm; pONHV, 6.70 ±1.27 mm ), followed by progressive atrophy (pRNFLT, 56.7 ±14.9 μm; pONHV, 2.7 ±0.41 mm at Month 6). mGCIPL thinning was detectable within 14 days of symptom onset (-0.58 μm/day; p < .001). Greater rates of ONH swelling between Screening and Enrollment were associated with subsequent vision change relative to Enrollment: each 0.15 mm /day increase in pONHV conferred higher odds of ≥2 dB interval VF worsening (OR, 1.84; 95% CI, 1.3-2.5; P < .001) and ≥10 letter BCVA worsening (OR, 1.52; 95% CI, 1.1-2.1; p < .001) by Month 6. Early reduction in swelling was associated with improved outcomes. Similar associations were observed at Month 2 with larger effect sizes. Increased ONH swelling rates between Screening and Enrollment were associated with VF and BCVA worsening between Enrollment and Month 6. mGCIPL thinning is detectable within 14 days of NAION symptom onset, preceding overt structural atrophy.

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