Evaluation of the Effects of Steroid Therapy on Visual Acuity, Visual Field, and Optical Coherence Tomography–Optical Coherence Tomography Angiography Parameters in Nonarteritic Anterior Ischemic Optic Neuropathy

BACKGROUND: To evaluate the effects of systemic corticosteroid therapy on visual and structural outcomes in patients with nonarteritic anterior ischemic optic neuropathy (NA-AION) treated with systemic corticosteroids vs those untreated, using optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: This retrospective study included 72 subjects: 23 steroid-treated patients with NA-AION, 24 untreated patients, and 25 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmic evaluation, including best-corrected visual acuity (BCVA), visual field testing, OCT, and OCTA imaging. Macular and peripapillary vessel densities were quantitatively analyzed. Additional analyses using analysis of covariance (ANCOVA) were performed to adjust for baseline visual acuity, age, sex, and systemic comorbidities. RESULTS: Baseline BCVA did not differ significantly between the patient groups. Greater unadjusted improvement in visual acuity was observed in the steroid-treated group (P = 0.031). However, after adjustment for baseline visual acuity and covariates, ANCOVA revealed only a borderline trend favoring steroid therapy (F(2,65) = 2.51, P = 0.089, partial η2=0.072). Similarly, mean deviation in visual field testing showed a modest but nonsignificant improvement after adjustment (F(1,30) = 2.19, P = 0.149, partial η2=0.068). OCT demonstrated significant thinning of the retinal nerve fiber layer and ganglion cell-inner plexiform layer in both NA-AION groups compared with controls, with no significant differences between treated and untreated patients. OCTA revealed reduced vessel density in all macular and peripapillary sectors in NA-AION eyes relative to controls (P < 0.001), without significant intergroup differences. CONCLUSIONS: Systemic corticosteroid therapy in NA-AION may be associated with greater functional improvement in visual acuity and visual field parameters; however, these findings should be interpreted with caution given the influence of baseline visual acuity and the retrospective study design. The absence of corresponding differences in structural and vascular OCT and OCTA parameters suggests that any potential functional benefit may occur independently of measurable microvascular restoration. Further prospective, controlled studies are required to clarify the role of corticosteroids in the management of NA-AION.