Early Macular Vessel Density Loss in Acute Ischemic Optic Neuropathy Compared to Papilledema: Implications for Pathogenesis

PURPOSE: This study compares macular and parafoveal vasculature in patients with optic disc swelling. METHODS: Twenty eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION), 39 eyes with papilledema at first presentation, and 22 eyes of normal subjects were imaged using optical coherence tomography angiography (OCT-A). Macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer thicknesses were measured in addition to macula and parafovea superficial and deep vasculature. RESULTS: Age- and gender-mixed models showed that the macular and parafoveal superficial and deep vasculature density values were significantly lower in NAION eyes than control eyes (P ≤ 0.0001 for all comparisons). All vessel density values were not statistically different between papilledema eyes and control eyes. Whole superficial and deep macula vasculature in the NAION eyes (45.9% ± 4.2%, 50.9% ± 6.5%) were significantly lower than in papilledema eyes (50.5% ± 4.6%, 57.3% ± 6.1%) (P = 0.03 and P = 0.01, respectively). No significant differences in GCC thickness were observed among NAION, papilledema, and control eyes. Whole superficial and deep macular vasculatures, but not macular GCC thickness, were significantly correlated with visual field mean deviation (r = 0.39, P = 0.001 and r = 0.41, P < 0.001, respectively). CONCLUSIONS: Macular OCT-A is able to show early macular vasculature abnormalities associated with optic nerve damage; this change occurs before detectable macular GCC atrophy. TRANSLATIONAL RELEVANCE: Macular vessel density measurement offers an opportunity to evaluate the optic nerve damage at initial presentation, but further longitudinal studies are needed.