PHOMS observed in both arteritic and nonarteritic anterior ischemic optic neuropathy in small cohort

Photo by Brett Jordan / Unsplash

Frontiers in Medicine Published April 6, 2026 Medically reviewed April 26, 2026 DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Note preliminary evidence of PHOMS in both A-AION and NA-AION from a small, exploratory cohort.

This exploratory retrospective cohort study analyzed 22 patients (22 eyes) with arteritic anterior ischemic optic neuropathy (A-AION) or nonarteritic anterior ischemic optic neuropathy (NA-AION), with 11 eyes in each subtype. The patients were enrolled from two prior prospective studies. The study compared the prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) and various structural retinal parameters between the two AION subtypes.

PHOMS was observed in both A-AION and NA-AION. The prevalence was 36.4% (4 of 11 eyes) in A-AION and 18.2% (2 of 11 eyes) in NA-AION, yielding an odds ratio of 2.57 (95% CI, 0.36–18.33; p = 0.635), which was not statistically significant. Bruch’s membrane opening diameter was similar between groups (A-AION: 1546.78 ± 134.14 µm; NA-AION: 1507.27 ± 133.95 µm). The mean peripapillary retinal nerve fiber layer thickness was reported as larger in A-AION than in NA-AION, though exact numbers were not provided. No differences were observed for macular ganglion cell layer volume, other retinal layer volumes, total retinal volume, or visual acuity.

Safety and tolerability data were not reported. Key limitations include the exploratory retrospective design, very small sample size, and the need for confirmation in larger, prospective studies. The authors suggest the presence of PHOMS in AION may reflect axoplasmic disturbance related to the ischemic insult itself rather than the underlying disease etiology. Given the preliminary nature of this evidence, these findings should not be used to guide clinical decision-making at this time.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

IntroductionA peripapillary hyperreflective ovoid mass-like structure (PHOMS) is an optical coherence tomography (OCT) specific finding associated with axoplasmic stasis in various optic neuropathies. Its occurrence in arteritic anterior ischemic optic neuropathy (A-AION) has not previously been described, and its prevalence and structural implications across AION subtypes remain incompletely understood.Materials & methodsIn this exploratory retrospective, age-matched study, patients with A-AION and nonarteritic AION (NA-AION) enrolled in two prior prospective studies between March 2021 and August 2024 were included. All eyes had undergone high-resolution spectral-domain OCT imaging of the optic nerve head as well as visual acuity assessment on first visit of diagnosis. PHOMS was identified according to Optic Disc Drusen Studies (ODDS) Consortium criteria.ResultsTwenty-two patients (22 eyes) were included, with 11 eyes in each AION subtype. PHOMS was observed in both A-AION and NA-AION. PHOMS was identified in 4 of 11 eyes (36.4%) with A-AION compared with 2 of 11 eyes (18.2%) with NA-AION. The estimated odds ratio for PHOMS presence in A-AION compared with NA-AION was 2.57 (95% CI, 0.36–18.33; p = 0.635). Bruch’s membrane opening diameter was similar between groups (A-AION: 1546.78 ± 134.14 μm; NA-AION: 1507.27 ± 133.95 μm), while mean peripapillary retinal nerve fiber layer thickness was larger in A-AION than in NA-AION. No differences were observed in macular ganglion cell layer volume, other retinal layer volumes, total retinal volume, or visual acuity between subtypes.DiscussionThe observation of PHOMS across ischemic optic neuropathy subtypes suggests that PHOMS in AION may reflect axoplasmic disturbance related to the ischemic insult itself rather than the underlying disease etiology, although confirmation in larger, prospective studies is warranted.