Evaluation of Changes in Optic Nerve Head and Macular Perfusion Before and After COVID-19 Onset
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By
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Seyfettin Erdem
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Sedat Ava
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Mehmet Emin Dursun
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Mine Karahan
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Leyla Hazar
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Ugur Keklikci
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February 28, 2026
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Clinical Scorecard: Evaluation of Changes in Optic Nerve Head and Macular Perfusion Before and After COVID-19 Onset
At a Glance
| Category | Detail |
|---|
| Condition | COVID-19-associated ocular microvascular alterations |
| Key Mechanisms | SARS-CoV-2 infection induces endothelial inflammation, dysfunction, and hypercoagulability leading to retinal microvascular changes |
| Target Population | Patients who contracted and recovered from COVID-19 |
| Care Setting | Ophthalmology clinics with access to optical coherence tomography angiography (OCTA) |
Key Highlights
- SARS-CoV-2 infects ocular tissues expressing ACE2 receptors and has been detected in retinal biopsies and tear fluid.
- COVID-19 causes retinal microvascular changes including reduced vessel density in optic nerve head and macular regions.
- OCTA enables non-invasive, high-resolution longitudinal assessment of retinal microcirculation before and after COVID-19 infection.
Guideline-Based Recommendations
Diagnosis
- Use polymerase chain reaction (PCR) testing to confirm COVID-19 infection.
- Perform comprehensive anterior and posterior segment ocular examinations including best-corrected visual acuity.
- Employ OCTA imaging to quantitatively assess retinal and optic nerve head vessel densities and foveal avascular zone.
Management
- Exclude patients with confounding ocular or systemic vascular diseases to isolate COVID-19 effects.
- Monitor recovered COVID-19 patients for retinal microvascular alterations using OCTA.
- Consider longitudinal OCTA imaging to detect early microvascular changes that may not be clinically evident.
Monitoring & Follow-up
- Repeat OCTA imaging at least one month post-COVID-19 recovery to evaluate changes in vessel density.
- Assess vessel density in superficial and deep capillary plexuses, optic nerve head, and radial peripapillary capillary network.
- Ensure image quality with signal strength >50 and absence of segmentation or motion artifacts.
Risks
- Potential for retinal vascular occlusions and microvascular damage due to COVID-19-induced hypercoagulability and endothelial dysfunction.
- Risk of vision-threatening complications secondary to microvascular impairment in optic nerve head and macula.
Patient & Prescribing Data
20 patients with baseline OCTA prior to COVID-19 infection who subsequently recovered from the disease
Significant reductions in optic nerve head and radial peripapillary capillary vessel densities were observed post-COVID-19, indicating microvascular impairment despite clinical recovery.
Clinical Best Practices
- Obtain baseline OCTA imaging in patients at risk to enable longitudinal comparison post-COVID-19 infection.
- Exclude confounding ocular and systemic diseases to accurately attribute microvascular changes to COVID-19.
- Use paired statistical analyses for within-subject longitudinal OCTA data to detect subtle microvascular alterations.
- Ensure rigorous image quality control with independent specialist review to validate OCTA measurements.
References
