Retinal Vascular Alterations in Chronic Non-Arteritic Anterior Ischemic Optic Neuropathy: A Dynamic Vessel Analyzer Study.

Non-arteritic anterior ischemic optic neuropathy (NAION) is a leading cause of sudden visual loss in older adults, often associated with vascular risk factors. The aim of this study was to investigate the retinal microvascular changes in chronic NAION and their relationship with systemic vascular conditions and obstructive sleep apnea (OSA). This retrospective observational study included 31 patients with chronic NAION (≥6 months from onset) and 17 age-matched healthy controls. Retinal microvascular parameters were assessed using the Dynamic Vessel Analyzer (DVA), including static and dynamic vessel metrics. Data were correlated with systemic vascular risk factors and polysomnographic findings. Arterial dilation amplitude was significantly reduced in eyes affected by chronic NAION compared to both contralateral unaffected eyes and healthy controls (p < .01). Static analysis revealed a significantly lower arteriovenous ratio (AVR) in both affected and unaffected eyes compared to controls. No significant differences were observed in venous parameters. Arterial diameter and dilation amplitude were positively correlated with ganglion cell layer thickness thickness and visual field sensitivity. OSA was diagnosed in 51% of patients, but no significant association was found between OSA and DVA parameters. In chronic NAION, DVA demonstrated impaired retinal arterial function, likely reflecting secondary effects of optic nerve damage. Retinal venous parameters remained unaffected. Cerebrovascular risk appeared more strongly associated with systemic vascular comorbidities than NAION itself. OSA, even in mild form, may contribute to disease severity.