The results of this study showed that the serum ATX, GFAP, and NfL levels of patients with combined optic neuropathy were significantly higher than those of patients with simple DR, and ATX was positively correlated with GFAP and NfL levels, indicating that serum ATX content was closely related to optic neuropathy in early DR. The gene discussed is ENPP2; the disease is Optic neuropathy.