Machine Learning Identifies Visual Disparities in Non-Arteritic Anterior Ischemic Optic Neuropathy at Presentation Between White and Asian Populations

Abstract

Purpose : Non-arteritic anterior ischemic optic neuropathy (NAION) causes patterns of visual field (VF) loss typical of anterior optic nerve injury. Recently, archetypal analysis (AA) showed quantification of these patterns (archetypes, AT) is possible, providing a potential to monitor changes and compare group data. Due to potential differences in the optic nerve head structure, we hypothesize that AA may show a difference in the patterns of NAION VF loss between White and Asian races.

Methods : We created an AA model from 3157 VFs (24-2, stimuli size III and V) from 728 study eyes from participants of all races aged 50-80 across eight countries in the QRK 207 NAION study. We cross-sectionally analyzed the 716 study eyes with stimulus size III VFs at presentation by self-reported race, examining AT relative weights (RW, total weight = 100%) of 567 White and 149 Asian participants. We compared differences in RW between the two groups with a Mann-Whitney U-test.

Results : At presentation, Asians had worse best corrected visual acuity (letter score, 58.2 ± 19.9, p < 0.001) than Whites (68.6 ± 21.1) and worse average total deviation (TD) for stimulus size III VFs (-20.9 ± 6.4, p < 0.001) than Whites (-15.5 ± 6.7). We found significant differences in the RWs of six ATs, with Asians having a higher RW for more severe ATs. AT1, a pattern of severe diffuse loss, was greater in Asians than Whites (RW 24% vs.12%, (p < 0.001), as were AT2, a pattern of inferior altitudinal loss (RW 26% vs 19%, p < 0.001) and AT4, a pattern of severe loss outside of the blind spot (RW 7.3% vs 5.6%, p = 0.01). Conversely, Asians had a lower RW for ATs with less severe loss including AT3, a pattern of mild diffuse loss (RW 5.5% vs. 13%, p < 0.001), AT5, a pattern of partial inferior altitudinal loss (RW 5.0% vs. 10%, p < 0.001), and AT8, a pattern of inferonasal quadrantanopia (RW 5.5% vs. 7.8%, p = 0.02).

Conclusions : AA revealed significant differences in VF patterns at presentation between White and Asian patients with NAION. VFs of Asian patients at presentation are likely to have higher RWs for AT patterns of more severe loss.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure 1. Ten archetypes for combined stimuli III and V visual fields. The average total deviation and relative weight values are shown. The color-coded scale represents total deviation.