Authors: Amit V. Mishra, Michael West, Rebecca George, Corey Smith, Charles Maxner, Balwantray Chauhan, Brennan Eadie

Author Disclosure Block: A.V. Mishra: None. M. West: None. R. George: None. C. Smith: None. C. Maxner: None. B. Chauhan: All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Allergan, CenterVue, Heidelberg Engineering, Santen, TopCon. B. Eadie: All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Allergan, Alcon.

Abstract Body:

Purpose: To determine the time course of retinal vascular degeneration that appears to occur as a result of retrograde trans-synaptic degeneration. This study is based on our recent observation that attenuation of the retinal vasculature can occur several years after a retro-geniculate insult in a manner that matches retrograde trans-synaptic degeneration of the retinal ganglion cell layer.

Study Design: Prospective, cross-sectional study.

Methods: Patients with an ischemic stroke to the retro-geniculate visual pathway causing a homonymous visual field defect were recruited. Patients were classified based on the time between their stroke and testing (2 to 6 months; 6 months to 1 year; 1 year to 2 years, greater than 2 years). Patients were excluded if they had a history of previous neurologic/ophthalmologic disease causing a visual field deficit. Each patient underwent optical coherence tomography (OCT) and OCT-angiography (OCTA) of the peripapillary and macular regions, disc photos, and visual field (Humphrey 24-2) at a single time point.

Results: Atrophy of the ganglion cell layer and superficial vascular plexus was noted in our patient population consistent with retrograde trans-synaptic degeneration. These deficits matched the pattern of visual field loss and showed a respect of the vertical midline. Vascular degeneration was noted within the first year of a retro-geniculate insult.

Conclusions: In this study, using OCTA, we show, in vivo, that retrograde trans-synaptic degeneration is associated with vascular degeneration. Further, we show that this vascular degeneration occurs within the first year following a retro-geniculate insult. This cross-sectional study helps better elucidate the time course of retinal changes post retro-geniculate stroke; however, prospective studies are needed to better characterize these changes.