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  • Review Article
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Structure–function correlates in anterior visual pathway lesions: a systematic review

Eye volume 39, pages 2340–2352 (2025)Cite this article

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Abstract

Visual field defects allow for the localisation of pathologic aetiologies along the entire visual system. However, various aetiologies and location of damage might lead to field defect at similar areas. We reviewed the literature systematically for cases of optic neuropathy with well-defined lesions along the anterior visual pathway from the retina to the lateral geniculate with the goal of correlating specific visual field manifestations with the underlying pathology at each segment. We searched MEDLINE, Scopus, Cochrane CENTRAL, and Web of Science databases on June 9, 2024. We included studies reporting damage at any segment of the anterior visual pathway with corresponding VF outcomes. Studies without primary data or new analyses were excluded. We also provided detailed figures from our own practice of cases with specific anterior visual pathway lesions at different locations and their respective visual field manifestations. Pathologies affecting the retinal ganglion cells and optic disc showed strong correlations with specific visual field defects such as arcuate or altitudinal patterns, and exhibited characteristic structural changes. More posterior lesions commonly produced visual field defects related to crossing fibres. These lesions were also associated with distinctive structural indicators. We emphasise the clinical importance of recognising both anterograde (from the retina) and retrograde (from the lateral geniculate body) axonal degeneration in the development of secondary optic atrophy. This review represents a guide for physicians in their assessment when evaluating visual field defects secondary to optic neuropathy.

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Fig. 1
Fig. 2: Damage at the level of the retinal ganglion cell layer.
Fig. 3: Damage at the level of optic disc.
Fig. 4: Damage at level of retrobulbar optic nerve.
Fig. 5: Damage at level of retrobulbar optic nerve.
Fig. 6: Damage at level of the optic chiasm.
Fig. 7: Damage at level of the optic chiasm.
Fig. 8: Damage at level of optic tract.

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Authors and Affiliations

  1. Department of Ophthalmology, The University of Jordan, Amman, Jordan

    Saif Aldeen Alryalat & Andrew G. Lee

  2. Department of Ophthalmology, University of Colorado School of Medicine, Sue Anschutz-Rodgers Eye Centre, Aurora, CO, USA

    Saif Aldeen Alryalat, Deidra St. Peter, Cara Capitena Young, Leonard K. Seibold & Malik Y. Kahook

  3. University of Texas Medical Branch, Galveston, TX, USA

    Janet L. Fan

  4. Baylor College of Medicine, School of Medicine, Houston, TX, USA

    Henry C. Skrehot & Paulina Truong

  5. McGovern Medical School, Houston, TX, USA

    Meghan Hunt

  6. The University of Jordan, Amman, Jordan

    Ayman Musleh & Lna Malkawi

  7. Department of Ophthalmology, Hashemite University, Amman, Jordan

    Osama Al-Deyabat

  8. Department of Ophthalmology, University of Illinois, Chicago, IL, USA

    Osama Al-Deyabat

  9. University of Colorado, Aurora, CO, USA

    Lna Malkawi

  10. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA

    Andrew G. Lee

  11. Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA

    Andrew G. Lee

  12. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA

    Andrew G. Lee

  13. Department of Ophthalmology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA

    Andrew G. Lee

  14. Texas A&M College of Medicine, Bryan, TX, USA

    Andrew G. Lee

  15. The University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Andrew G. Lee

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  1. Saif Aldeen Alryalat
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Contributions

Saif Aldeen Alryalat: conceptualisation, methodology, writing—original draft. Janet L. Fan: investigation, data curation. Henry C. Skrehot: investigation, data curation. Paulina Truong: investigation, data curation. Meghan Hunt: investigation, data curation. Ayman Musleh: data curation, supervision. Osama Al-Deyabat: writing—original draft, supervision. Lna Malkawi: writing—original draft. Deidra St. Peter: writing—review & editing. Cara Capitena Young: writing—review & editing. Leonard K. Seibold: supervision, writing—review & editing. Malik Y. Kahook: conceptualisation, supervision, writing—review & editing. Andrew G. Lee: conceptualisation, supervision, writing—review & editing.

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Correspondence to Saif Aldeen Alryalat.

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A.G.L. is a member of the Eye editorial board.

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Alryalat, S.A., Fan, J.L., Skrehot, H.C. et al. Structure–function correlates in anterior visual pathway lesions: a systematic review. Eye 39, 2340–2352 (2025). https://doi.org/10.1038/s41433-025-03868-1

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