What does this research mean for the field?

Baseline retinal nerve fiber layer (RNFL) thickness under 150 μm serves as a predictive biomarker for successful visual outcomes following endoscopic transnasal optic canal decompression in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

What question did this study set out to answer?

This study aims to identify retinal nerve fiber layer thickness as a predictive biomarker for surgical success in patients with NAION receiving optic canal decompression.

June 10, 2026Open Access

Baseline retinal nerve fiber layer thickness as a predictive biomarker for endoscopic optic canal decompression in NAION: towards a precision medicine approach

Key Points

This study aims to identify retinal nerve fiber layer thickness as a predictive biomarker for surgical success in patients with NAION receiving optic canal decompression.
Included 71 patients diagnosed with NAION, divided into ETOCD (n=30) and medical management (n=41) groups.
Assessed best-corrected visual acuity, visual field index, mean deviation, pattern standard deviation, and retinal nerve fiber layer thickness at baseline and 3 months post-treatment.
Performed multivariable regression and interaction analyses to explore RNFL as a predictive biomarker.
The ETOCD group exhibited superior overall efficacy (Adjusted β = -0.41, P < 0.001).
Patients with moderate RNFL thickness (< 150 μm) had a profound therapeutic response (OR 7.88, 95% CI: 2.07–29.94, P = 0.002).
Significant radial peripapillary capillary reperfusion was observed in responders, reinforcing the 'osseous compartment syndrome' hypothesis.

Abstract

Abstract Background Nonarteritic anterior ischemic optic neuropathy (NAION) remains a major cause of blindness with no consensus on treatment. The heterogeneity of patient outcomes suggests that a “one-size-fits-all” approach is ineffective. This study aimed to identify structural biomarkers to define the therapeutic window for endoscopic transnasal optic canal decompression (ETOCD) and explore its mechanism via vascular reperfusion imaging. Methods Seventy-one patients diagnosed with NAION were included and categorized into two groups: an ETOCD group ( n = 30) and a medical management group ( n = 41). Best-corrected visual acuity (BCVA), visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD), and retinal nerve fiber layer (RNFL) thickness were assessed at baseline and 3 months after treatment. Optical coherence tomography angiography (OCTA) was utilized to evaluate microvascular recovery. Multivariable regression and interaction analyses were performed to investigate RNFL as a predictive biomarker. Results While ETOCD showed superior overall efficacy (Adjusted β = -0.41, P < 0.001), a critical treatment-by-biomarker interaction was identified (P for interaction = 0.014). Patients with moderate edema (RNFL < 150 μm) exhibited a profound therapeutic response (OR 7.88, 95% CI: 2.07–29.94, P = 0.002), whereas those with massive edema derived minimal benefit. OCTA analysis in responders revealed significant radial peripapillary capillary reperfusion, providing mechanistic support of the “osseous compartment syndrome” hypothesis. Conclusion We identified baseline RNFL thickness (< 150 μm) as a potential predictive biomarker for surgical success in NAION. These findings support an alternative therapeutic strategy from empiric treatment to biomarker-guided precision decompression, bridging the gap between anatomical pathology and surgical intervention. Trial registration Retrospectively registered.

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Cite This Study

Yao et al. (Mon,) studied this question.

synapsesocial.com/papers/6a28fecb6f82f25be989bf48 https://doi.org/https://doi.org/10.1186/s12967-026-08361-1

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