Demographic and Phenotypic Analysis of Acute Macular Neuroretinopathy: Insights from a Large Single-Center Retrospective Cohort Study

Abstract

Purpose : Acute macular neuroretinopathy (AMN) is a rare retinal disorder characterized by sudden-onset paracentral scotomas and subtle changes in the macular region. This study explores the demographics and phenotypic characteristics of individuals affected by AMN, aiming to enhance our understanding of this condition.

Methods : In this retrospective analysis, we studied individuals with OCT-documented AMN attending Moorfields Eye Hospital between 2014 and 2021. Clinical data, including medical histories, visual acuity assessments, multimodal imaging including optical coherence tomography and infrared imaging, were reviewed to elucidate the phenotypic variations and disease progression in AMN. We proposed a staging of AMN (Acute, subacute and resolved stages) according to the phenotype on OCT and infrared images to better analyse the data. Additionally, the study explored potential associations between AMN and systemic conditions in patients with atypical AMN presentation.

Results : 92 eyes from 64 patients diagnosed with AMN were assessed. Bilateral AMN was found in 28 patients (50.6%). The median age was 34 years (range: 15 – 64 years), with females comprising 78.1% (n=50) of the cohort. The mean best-corrected visual acuity (BCVA) at presentation was 0.1 logMAR (range: 0 – 1.9 logMAR)*. Multimodal imaging analysis revealed 38 cases (41.3%) as acute, 41 cases (44.6%) as subacute, 8 cases (8.7%) as resolved, and 5 cases (5.4%) were indeterminate. Foveal involvement appeared in 20 cases (21.7%), while multifocal lesions were observed in 41 cases (44.6%). Notably, there were 10 patients (15.6%) reporting viral infections, including flu-like illness and COVID-19, prior to AMN onset. Atypical presentation of AMN was detected in 9 eyes.Those cases were associated with lower initial visual acuity and potential systemic risk factors.

Conclusions : The findings reveal a spectrum of demographic characteristics within the AMN population. Phenotypic analysis uncovered distinct imaging patterns and disease manifestations, shedding light on the heterogeneity of AMN presentations. The insights gained may facilitate earlier diagnosis, and the identification of potential systemic association of the atypical cases.

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