Longitudinal widefield OCT optic nerve thickness measurements in a case of incipient non-arteritic ischemic optic neuropathy.

Purpose: Widefield swept-source optical coherence tomography angiography (SS-OCTA) scans were combined with a semi-automated algorithm for the early detection and resolution of optic nerve edema in a case of incipient non-arteritic anterior ischemic optic neuropathy (NAION). Observations: An incidental case of incipient NAION was identified in a 71-year-old woman enrolled in an ongoing prospective SS-OCTA imaging study using 12 × 12 mm scans that allowed imaging of both the macular and optic disc regions of patients with age-related macular degeneration (AMD). Early intervention with systemic corticosteroids led to the resolution of optic disc edema without subsequent vision loss. A novel semi-automated algorithm was used to quantify the onset and resolution of optic nerve edema and edema in the surrounding retina. Conclusions and importance: This use of 12 × 12 mm SS-OCTA scans and a semi-automated algorithm can significantly improve the detection and management of incipient NAION in clinical practice with the possibility that early detection would facilitate earlier intervention and better vision preservation in this condition. The use of widefield OCT imaging in conjunction with this novel algorithm in eyes at risk for optic nerve and macular edema could have broader implications for other retinal diseases in which optic disc and macular edema might arise such as diabetic retinopathy. Integrating this methodology into routine ophthalmic evaluations will enable clinicians to identify the onset of edema prior to vision loss, thereby improving patient outcomes.