Journal ArticleDOI
Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful
Frank Ischemic,Frank J. Hooper,David Kaufman,Nancy J. Newman,P. David Wilson,Z. Suzanne Zam,John S. Kennerdell,Anna Tyutyunikov,Russell Edwards,Todd Goodglick,Deborah Lang,Kimberly Peele,Sophia M. Chung,Diana Mekelburg,John B. Holds,John B. Selhorst,Mark Malton,Sonia Armstrong,Yvonne Mccracken,Eugene Benjamin,Carol Dellinger,Traci Hunter Medlin,Barbara Kinsler,Mike Mcowen,Donna Russell,Timothy Saunders,Gregory S. Kosmorsky,Tina Kiss,Cate Reinhard,Laura Venne,Janet Edgerton,Tami Fecko,Susannah Hanson,Brian Kraus,Deborah Ross,Nancy Tomsak,Pamela Vargo,Rufus Willis,Steven E. Feldon,Kerry Zimmerman,Kristin E. Anderson,Richard Cortez,Karen Deblanc,Judy Hulse,Ronald B. Morales,Tracy Nichols,Lillian Reyes,Nadine Rodarte Ochoa,Daniel Romo,Alfredo A. Sadun,Mary Steber,Frances Walonker,Donna Loupe,Diana Coffman,Harvey Cole,Ted H. Wojno,Barry Skarf,Colleen Wojtala,Mark Croswell,Wendy Gilroy,Christian Mageli,Dena McDonald,George Ponka,Rosa A. Tang,Melissa Hamlin,Jewel Curtis,Jay Forman,Kenneth Hyde,Kirk Mack,Portia Tello,Anthony C. Arnold,Berniee Cibener,Melody Acero,Bobbi Ballenberg,Anne Bolton,Robert J. Goldberg,Lynn K. Gordon,Michael A. Heneghan,Howard R. Krauss,Jackie Sanguinei,Robert Stalling,Jenja Yadegaran,Wayne T. Cornblath,Barbara Michael,Donna Campbell,Cheryl Caudill,Christine Nelson,Jonathan D. Trobe,Lenworth N. Johnson,Gaye Baker,Coy Cobb,Philip Custer,Sharon Turner,Roy D. Wilson,Brian R. Younge,Jacqueline A. Leavitt,Rebecca Nielsen,Jody Allen,Barbara Eickhoff,James A. Garrity,Jacqueline Ladsten,Kathleen Lebarron,Thomas P. Link,Jay A. Rostvold,Karen Weber,Warren L. Felton,Tracy Boney,Danielle Gabriel,Daniel David,Lahn Fendelander,Daniel Geller,Timothy R. Jordan,Christian Kim,Craig Munger,Anne Romandy,George Sanborn,Bradley Schwartz,Carl Sheusi,Constance Smith,Kathy Talley,Sandya Thimmappa,Eric R. Eggenberger,Suzanne Bickert,Robert Granadier,Sandra Holliday,Thomas J. Moore,Jaya Varadarajan,Deborah I. Friedman,Patricia Jones,Haris Amin,Thomas A. Bersani,Cynthia Briglin,James Fooks,Michael Graham,Milton James,Gary Michalec,Hoang Nguyen,Jonathan C. Horton,Maeve Chang,Lou Anne Aber,Erik Lindstrom,Stuart R. Seiff,John Guy,Amye Francis,Latif Hamed,Alan Lessner,Donna Mcdavid,Diana Shamis,James S. Goodwin,Martin E. Lindeman,Allen M. Putterman,Phyllis Bobak,Robert Baker,Judy Beck,David L. Cowen,Avrom Epstein,M.B. Hanson,Toni Scoggins,Ann M. Rodavitch,Brenda Gore,Andrea Blake,Michele Heroux,Rani Kalsi,Charlene Krauch,Mary Ann Millar,Mitchell Wolin,Rita Jean Brady,Regina Hansen,Michael Briggs,Karkarla V. Chalam,Barbara Danner,Beverly Simons,Anne Stewart,Kathleen B. Digre,Lizbeth Malmquist Webb,Terrell Blackburn,Susan Baggaley,Richard C. E. Anderson,Charles Juarez,Bonnie Kaye,Paul D. Langer,Aditya Mishra,Paula Morris,Sandra Osborn,Bhupendra C. Patel,Tessie Priskos,Sandra Staker,Judith E. A. Warner,Christine Evans,Allison Aylor,Carolyn Childress,Helen Dickerson,Jane Fleming,Nomine Harris,L. Sharon Hoyle,Ellen Murphy,James Scott,Karen Summerville,Mariann Terrell,Lillian Tyler,John V. Linberg,Lenore Breen,Michelle Michael,Charlene Campbell,Brian Ellis,Nancy Groves,Robert Hobson,Gordon Mcgregor,Laura Shepherd,Edward S. Cohn,Patricia Manatrey,Sara Casey,John W. Johnson,Coletti Kronner,Virginia Regan,Patricia Streasick,Shalom E. Kelman,Michael J. Elman,Aim M. Rodavitch,Roberta W. Scherer,Barbara Crawley,Cheryl Hiner,Lucy Howard,Patricia Langenberg,Olga Lurye,Sara Riedel,Michelle Sotos,Laureen Spioch,Joann Starr,Judy Urban,Mark Waring,Donald Everett,Kay Dickersin,Robert McCarter,Stuart R. Seiff +234 more
TLDR
Results from the Ischemic Optic Neuropathy Decompression Trial indicate that optic nerve decompression surgery for NAION is not effective, may be harmful, and should be abandoned.Abstract:
Objective. —To assess the safety and efficacy of optic nerve decompression surgery compared with careful follow-up alone in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Design. —The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. Setting. —Twenty-five US clinical centers. Participants. —The IONDT ceased recruitment on October 20, 1994, on the recommendation of its Data and Safety Monitoring Committee. The preliminary results presented herein are based on data as of September 8,1994, from 244 patients with NAION and visual acuity of 20/64 or worse. One hundred twenty-five patients had been randomized to careful follow-up, and 119 had been randomized to surgery, with 91 and 95, respectively, having completed 6 months of follow-up. Intervention. —Patients in the surgery group received optic nerve decompression surgery and follow-up ophthalmologic examinations; those in the careful follow-up group received ophthalmologic examinations at the same times as the surgery group. Main Outcome Measures. —Gain or loss of three or more lines of visual acuity on the New York Lighthouse chart at 6 months after randomization, as measured by a technician masked to treatment assignment. Results. —Patients assigned to surgery did no better when compared with patients assigned to careful follow-up regarding improved visual acuity of three or more lines at 6 months: 32.6% of the surgery group improved compared with 42.7% of the careful follow-up group. The odds ratio (OR) for three or more lines better, adjusted for baseline visual acuity and diabetes, was 0.74 (95% confidence interval [CI], 0.39 to 1.38). Patients receiving surgery had a significantly greater risk of losing three or more lines of vision at 6 months: 23.9% in the surgery group worsened compared with 12.4% in the careful follow-up group. The 6-month adjusted OR for three or more lines worse was 1.96 (95% CI, 0.87 to 4.41). No difference in treatment effect was observed between patients with progressive NAION and all others. Conclusion. —Results from the IONDT indicate that optic nerve decompression surgery for NAION is not effective, may be harmful, and should be abandoned. The spontaneous improvement rate is better than previously reported. ( JAMA . 1995;273:625-632)read more
Citations
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The eye in hypertension.
Tien Yin Wong,Paul Mitchell +1 more
TL;DR: Recognition of the ocular effects of blood pressure could allow physicians to better manage patients with hypertension, and to monitor its end-organ effects.
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Ischemic optic neuropathy.
TL;DR: Emerging information on the various factors that influence the optic nerve circulation, and also the various systemic and local risk factors which play important roles in the development of various types of ischemic optic neuropathy have given a better understanding of their pathogeneses, clinical features and management.
Journal ArticleDOI
Incidence of Nonarteritic Anteripr Ischemic Optic Neuropathy
TL;DR: Ex extrapolation of the findings to the United States white population indicates that nearly 5,700 new cases of acute nonarteritic anterior ischemic optic neuropathy may be expected to occur each year in this group of adults.
Journal ArticleDOI
Idiopathic intracranial hypertension.
TL;DR: Idiopathic intracranial hypertension is the term to be adopted instead of pseudotumor cerebri, and prompt diagnosis and thorough evaluation and treatment are crucial for preventing visual loss and improving associated symptoms.
Journal ArticleDOI
The fellow eye in NAION: report from the ischemic optic neuropathy decompression trial follow-up study.
Nancy J. Newman,Roberta Scherer,Patricia Langenberg,Shalom E. Kelman,Steven E. Feldon,David I. Kaufman,Kay Dickersin +6 more
TL;DR: Follow-up data from the IONDT cohort provide evidence that the incidence of fellow eye NAION is lower than expected, and increased incidence is associated with poor baseline visual acuity in the study eye and diabetes, but not age, sex, smoking history, or aspirin use.
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Anterior Ischemic Optic Neuropathy
TL;DR: The clinical features of anterior ischemic optic neuropathy are reviewed and its pathogenesis and treatment are discussed.
Anterior ischemic optic neuropathy.
TL;DR: Anterior ischemic optic neuropathy (AION), one of the most prevalent and visually crippling diseases in the middle-aged and elderly, potentially bilateral, is due to acute ischemia of the optic nerve head as discussed by the authors.