Journal article
Early Optic Nerve Head Swelling Rate is Associated with Worsening of Visual Outcomes in Nonarteritic Anterior Ischemic Optic Neuropathy
Ophthalmology (Rochester, Minn.), Vol.133(10), pp.1242-1254
05/18/2026
DOI: 10.1016/j.ophtha.2026.05.013
PMID: 42155674
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.
Details
- Title: Subtitle
- Early Optic Nerve Head Swelling Rate is Associated with Worsening of Visual Outcomes in Nonarteritic Anterior Ischemic Optic Neuropathy
- Creators
- Brian Woods - University Hospital GalwayDavid Szanto - Icahn School of Medicine at Mount SinaiJui-Kai Wang - The University of Texas Southwestern Medical CenterAsala Erekat - Icahn School of Medicine at Mount SinaiAaron Golden - Rhodes UniversityMona K Garvin - University of IowaZoe R Williams - University of RochesterEdward F Linton - University of IowaRandy H Kardon - University of IowaMark J Kupersmith - Icahn School of Medicine at Mount Sinai
- Resource Type
- Journal article
- Publication Details
- Ophthalmology (Rochester, Minn.), Vol.133(10), pp.1242-1254
- DOI
- 10.1016/j.ophtha.2026.05.013
- PMID
- 42155674
- NLM abbreviation
- Ophthalmology
- ISSN
- 0161-6420
- eISSN
- 1549-4713
- Publisher
- Elsevier
- Grant note
- York, New York (UTSW Ophthalmology Challenge Grant) National Eye Institute, Bethesda, Maryland NEI: R01 EY015473 Department of Veteran Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Rehabilitation Research and Development: I50 RX003002, I01RX003797
Supported by the Health Research Board (grant no.: ICAT-2022-001) and the Irish Clinical Academic Training Programme, which is supported by the Health Service Executive, National Doctors Training and Planning, the Health and Social Care, Research and Development Division, the Northern Ireland Medical and Dental Training Agency, the Department of Agriculture, Food and the Marine and the College of Anaesthesiologists of Ireland; the New York Eye and Ear Infirmary Foundation, New York, New York; the Barry Family Center for Ophthalmic Artificial Intelligence and Human Health; the Shulman Family NAION Fund, New York, New York; the Neuro-Ophthalmology Research Fund of New York Eye and Ear Infirmary, New York, New York; Research to Prevent Blindness, Inc., New York, New York (unrestricted grant to the Department of Ophthalmology and UTSW Ophthalmology Challenge Grant); the National Eye Institute, Bethesda, Maryland (grant no.: NEI R01 EY015473); and the Department of Veteran Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Rehabilitation Research and Development (grant nos.: I50 RX003002 and I01RX003797).The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.r York, New York (unrestricted grant to the Department of Ophthalmology and UTSW Ophthalmology Challenge Grant) ; the National Eye Institute, Bethesda, Maryland (grant no.: NEI R01 EY015473) ; and the Department of Veteran Affairs (VA) Center for the Prevention and Treatment of Visual Loss, Rehabilitation Research and Development (grant nos.: I50 RX003002 and I01RX003797) .
- Language
- English
- Electronic publication date
- 05/18/2026
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Electrical and Computer Engineering; The University of Iowa Institute for Vision Research; Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
- Record Identifier
- 9985164727202771
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