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

Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute optic neuropathy in the elderly population and is strongly associated with vascular and microcirculatory abnormalities. We read with interest the study investigating retinal vascular changes in chronic NAION by Dynamic Vessel Analyzer (DVA) measurements. Although the results provide valuable information on the changes of retinal vasculature in NAION, some methodological issues need to be addressed. Among them, we find the possible violation of statistical independence in the case of bilateral disease, the lack of adjustment for important vascular comorbidities, the cautious interpretation of the arteriovenous ratio (AVR) as a surrogate marker of cerebrovascular risk, and the limitations of the retrospective cross-sectional design in establishing predictive value. Future prospective studies with adequate statistical modeling and extensive adjustment for vascular risk factors are necessary to confirm these associations and clarify their clinical significance.