Development of a predictive model for visual outcomes and risk factors of bilateral involvement for non-arteritic anterior ischemic optic neuropathy (NAION) in Chinese patients

Background This study aimed to explore the risk factors associated with bilateral involvement and to develop a predictive model for visual prognosis in Chinese patients with non-arteritic anterior ischemic optic neuropathy (NAION). Methods In this retrospective database-related meta-analysis, we retrospectively identified patients with NAION from the Chinese Neuro-Ophthalmic Diseases project database between September 2020 and December 2024. The clinical characteristics of the patients were summarized. Logistic and stepwise regression analyses were performed to identify the factors associated with bilateral involvement. Patients were randomly divided into training (75%) and validation (25%) cohorts. Least absolute shrinkage and selection operator (LASSO) and logistic regression analyses were used to develop a model for predicting factors associated with a best-corrected visual acuity (BCVA) ≤ 0.3 (decimal). Results The study included 895 patients (560 [62.57%] males, 1,128 eyes; mean age: 55.6 ± 10.4 years). Bilateral NAION was present in 226 (25.3%) patients. At the follow-up examination, 522 patients (730 eyes) had a BCVA ≤ 0.3 in 369 (50.6%) eyes. Bilateral NAION involvement was associated with hyperlipidemia (t = 2.02, P = 0.04), hematologic disorders (t = 2.31, P = 0.02), and smoking (t = 4.79, P < 0.01). Risk factors for a BCVA ≤ 0.3 at follow-up were a lower BCVA at onset (odds ratio [OR] = 0.72, 95% confidence interval [CI]: 0.64–0.82, P < 0.01), diabetes mellitus (OR = 2.97, 95% CI: 1.10–8.03, P = 0.03), hyperhomocysteinemia (OR = 11.59, 95% CI: 1.87–71.97, P = 0.01), and macular serous detachment (OR = 6.70, 95% CI: 1.34–33.40, P = 0.02). The area under the receiver operating characteristic curve was 0.87 (95% CI: 0.83–0.87) for the training cohort and 0.86 (95% CI: 0.80–0.86) for the validation cohort. Conclusions Hyperlipidemia, hematologic disorders, and smoking were significant risk factors for bilateral NAION, whereas the severity of vision loss at onset, diabetes mellitus, hyperhomocysteinemia, and macular serous detachment were associated with poor visual prognosis in Chinese patients with NAION.