Diffusion Tensor Imaging As A Predictor Of Visual Outcome In Indirect Traumatic Optic Neuropathy: A Prospective Cohort Study
Published 2026 - 44th Congress of the ESCRS
Reference: POANT038 | Type: Poster | DOI: 10.82333/03qy-2f69
Authors: Dr Upasna Sinha* 1 , Dr Amit Raj 2 , Dr Tribhuwan Kumar 3 , Dr Anil Kumar 4 , Dr Saraj Singh 5 , Dr Bhawesh Saha 2 , Dr Dev Kant 2 , Dr Amit Kumar 2
1Radio Diagnosis,All India Institute of Medical Sciences,Patna,India, 2Ophthalmology,All India Institute of Medical Sciences,Patna,India, 3Physiology,All India Institute of Medical Sciences,Patna,India, 4Trauma Surgery,All India Institute of Medical Sciences,Patna,India, 5Neuro Surgery,All India Institute of Medical Sciences,Patna,India
Purpose
To evaluate diffusion tensor imaging (DTI) parameters of the optic nerve as diagnostic and prognostic indicators in patients with indirect traumatic optic neuropathy (I-TON), including those with associated head injury unable to report visual loss.
Setting
The present study intends to correlate the findings of MRI-based Diffusion Tensor Imaging, OCT and VEP to the extent of vision loss and presence of other prognostic indicators in isolated Indirect Traumatic Optic Neuropathy(I-TON) as well as in the setting of significant head injury, in order to discover signs which can help in early diagnosis of I- TON.
Methods
Patients aged 6–70 years presenting with post-traumatic vision loss without direct optic nerve injury were recruited and divided into two groups: isolated I-TON (Group 1) and patients with significant head injury unable to report visual symptoms (Group 2). All patients underwent CT to exclude direct optic nerve injury followed by MRI with DTI after neurosurgical clearance. Fractional anisotropy (FA), mean diffusivity (MD), and axial diffusivity (AD) were analyzed for both optic nerves. Optical coherence tomography (macular and RNFL) and flash visual evoked potential (VEP) were performed when feasible. Visual acuity, OCT, and VEP were reassessed at 4–6 weeks and 10–12 weeks, and correlated with DTI findings.
Results
37 patients have been screened (Group 1: n=23; Group 2: n=14), with male predominance (30/37). Mean male age was 29.9 ± 15.0 years (range 6–64). In Group 1, seven patients fulfilled inclusion criteria; six have completed baseline and follow-up assessments, and one is undergoing first follow-up. In Group 2,Ten completed baseline evaluation up to CT, with one death due to injury-related complications. MRI-DTI was performed in seven eligible participants (six from Group 1, one from Group 2). Mean FA values were reduced (right eye: 0.53 ± 0.15; left eye: 0.42 ± 0.09). MD values were 0.97 ± 0.31 and 1.16 ± 0.45 ×10⁻³ mm²/s, while AD values were 1.78 ± 0.11 and 1.72 ± 0.36 ×10⁻³ mm²/s.
Conclusions
DTI demonstrates consistent microstructural abnormalities in I-TON and shows promise as an objective diagnostic and prognostic tool, particularly in patients unable to reliably report visual loss. Ongoing recruitment will further establish its role in predicting visual outcomes and guiding early intervention