Comparative Topographical Analysis of Choroidal Microvascular Dropout Between Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE. To identify the presence of choroidal microvascular dropout (MvD) in nonarteritic anterior ischemic optic neuropathy (NAION) eyes and to characterize the topographical distribution for the mechanistic interpretation of MvD development. METHODS. We performed optical coherence tomography angiography on 47 open-angle glaucoma (OAG) and 19 NAION eyes with beta-zone peripapillary atrophy (beta PPA). We recorded the presence of MvD and compared between the peripapillary topographical measures of MvD, retinal nerve fiber layer (RNFL) defect, and beta PPA in angular width and location. RESULTS. MvD was present in both diseases, marginally more frequently in NAION eyes (19/19, 100.0%) than in OAG eyes (38/47, 80.6%, P = 0.050), without a discernable difference in appearance. NAION eyes also showed wider MvD and RNFL defects compared to OAG eyes (both P < 0.001). In topographical measurements, the distribution of MvD showed a strong correspondence to superimposition areas of beta PPA and RNFL defects, more distinctly than to RNFL defects (all P < 0.001). The outline of superimposition area also remarkably resembled the MvD area. CONCLUSIONS. MvD was present in both the OAG and NAION groups. The beta PPA-RNFL defect superimposition area topographically and morphologically matched MvD. Further investigations are needed to elucidate the role of RNFL defects in the pathogenesis of MvD and the clinical significance.

Automated summary

The study identified the presence of choroidal microvascular dropout (MvD) in both nonarteritic anterior ischemic optic neuropathy (NAION) and open-angle glaucoma (OAG) eyes, with a higher frequency in NAION eyes and larger areas of MvD and RNFL defects. The distribution of MvD showed a strong correspondence to superimposition areas of beta PPA and RNFL defects, highlighting a potential mechanistic relationship between these factors.