Prelaminar Hyperreflective Lines Associated With Non-Arteritic Anterior Ischaemic Optic Neuropathy

By
Anas Alkhabaz
Bianca Chan
Yulan Ren
Rishita Rama Pujari
Jamie Zhang
Hugo Wu
Yaping Joyce Liao
October 9, 2026

Objective:

To characterize clinical and imaging features of NAION eyes with optic disc drusen (ODD) or hyperreflective lines (HRLs) on enhanced-depth imaging OCT, and assess their association with outcomes.

Approach:

Design and setting: Retrospective analysis of a prospectively recruited optic-neuropathy dataset from Stanford University, collected from 2020 through 2025.
Participants: Among 177 patients with NAION, investigators identified 42 patients (58 eyes) with ODD-like features and compared them with 45 patients (66 eyes) without those features.
Imaging and analysis: ODD and HRLs were assessed using EDI-OCT. ODD-AION eyes had an ODD at least 100 µm in largest dimension; HRL-AION eyes had an HRL without an ODD of that size. Eye-level comparisons used age-adjusted mixed-effects models accounting for inter-eye correlation.

Key Findings:

ODD-like features were identified in 23.7% of the NAION cohort; 25 patients had HRLs and 17 had ODD.
Patients with ODD-like features were more often diagnosed before age 50 than those without them (26% vs 2.2%; adjusted p = 0.010).
Cardiovascular risk factors and sex distribution were similar between groups. Among patients with unilateral NAION and ODD-like features, 88% had ODD and/or HRLs in the fellow eye.
Eyes with ODD-like features had better median logMAR visual acuity than eyes without them (0.24 vs 0.54; adjusted p = 0.027), as well as greater GCC and RNFL thickness.
Visual-field mean deviation did not differ between groups. Bruch’s membrane opening was smaller in eyes with ODD-like features.

Interpretation:

In this cohort, ODD-like features in NAION were associated with younger age at diagnosis and better visual acuity and retinal nerve-fibre and ganglion-cell-complex thickness measurements. The supplied article context does not report the results of the HRL-only versus ODD subgroup analysis.

Limitations:

The study was retrospective and conducted at a single institution.
The supplied context does not include the results of the HRL-AION and ODD-AION subgroup comparison or the remainder of the article.