Chuter, B.; White, W.; Hollingsworth, T. J.; Wang, X.; Guan, L.; Kim, M. Y.; Jablonski, M. M.

Objective: To determine whether non-axon optic nerve morphometric features correlate with clinical visual function as strongly as the traditional axon count gold standard. Design: Cross-sectional histological analysis with longitudinal clinical correlation. Subjects: Eighteen mice from three strains: C57BL/6J (n=6), BXD51 (n=6), and DBA/2J (n=6). Methods: Left eye (OS) optic nerves from mice euthanized at 12 months of age were resin-embedded and stained with p-phenylenediamine. Bright-field cross-sectional images were segmented using an AxonDeepSeg-based workflow to generate axon, myelin, whole nerve, and glial coverage masks for morphometric quantification. Seven morphometrics were extracted: axon count (nAx), axon density (AxDen), glial coverage area ratio (GliaR), mean solidity (Sol), mean axon diameter (AxDiam), mean myelin area (MyArea), and mean axon-myelin area (AxMyArea). Morphometrics were correlated with longitudinal clinical data collected at 1, 3, 6, 9, and 12 months, including visual acuity (VA), contrast threshold, intraocular pressure (IOP), and pattern electroretinography P50 and N95 amplitudes (PERG P50 and N95). Main Outcome Measures: Pearson correlation coefficients were used to assess associations between morphometric features and clinical measures, and Fisher z-transformed meta-analytic correlations were used to aggregate these associations across ages. Results: VA and contrast threshold demonstrated strong correlations with GliaR that matched or exceeded nAx. Meta-analysis across ages revealed GliaR correlated with VA (r = -0.84, p = 4.49 x 10-21) and contrast threshold (r = 0.86, p=7.55 x 10-23), comparable to nAx correlations with VA (r = 0.80, p=8.13x10-17) and contrast threshold (r = -0.80, p= 1.74x10-16). Structure-function relationships shifted with age: at 6 months, GliaR had the strongest correlation with contrast threshold (r = 0.96), while at 12 months, AxDiam became the dominant correlate of both VA (r = 0.77) and contrast threshhold (r = -0.74). IOP, PERG P50, and PERG N95 exhibited weak correlations with all morphometrics (|r| < 0.27). Conclusions: Non-axon morphometrics, particularly glial coverage area ratio, correlate with visual function as strongly as traditional axon count. Automated optic nerve assessment should incorporate glial and other non-axon features. Further, stage-aware biomarker selection may better capture structure-function relationships in glaucoma.