Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy

• Type of Material: Article
• Authors: Edward J. Atkins, Emory University; Beau Benjamin Bruce, Emory University; Nancy J Newman, Emory University; Valerie Biousse, Emory University
• Language: English
• Date: 2010-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2010 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.survophthal.2009.06.008
• Title of Journal or Parent Work: Survey of Ophthalmology
• ISSN: 0039-6257
• Volume: 55
• Issue: 1
• Start Page: 47
• End Page: 63
• Grant/Funding Information: Dr Newman is a recipient of a Research to Prevent Blindness Lew R. Wasserman Merit Award.; This study was supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc, New York, New York, and by core grant P30-EY06360 (Department of Ophthalmology) from the National Institute of Health, Bethesda, Maryland.
• Keywords: treatment; nonarteritic anterior ischemic optic neuropathy; pathogenesis; Ischemic Optic Neuropathy Decompression Trial (IONDT)
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Opthamology

Abstract

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common clinical presentation of acute ischemic damage to the optic nerve. Most treatments proposed for NAION are empirical and include a wide range of agents presumed to act on thrombosis, on the blood vessels, or on the disc edema itself. Others are presumed to have a neuroprotective effect. Although there have been multiple therapies attempted, most have not been adequately studied, and animal models of NAION have only recently emerged. The Ischemic Optic Neuropathy Decompression Trial (IONDT), the only class I large multicenter prospective treatment trial for NAION, found no benefit from surgical intervention. One recent large, nonrandomized controlled study suggested that oral steroids might be helpful for acute NAION. Others recently proposed interventions are intravitreal injections of steroids or anti-vascular endothelial growth factor (anti-VEGF) agents. There are no class I studies showing benefit from either medical or surgical treatments. Most of the literature on the treatment of NAION consists of retrospective or prospective case series and anecdotal case reports. Similarly, therapies aimed at secondary prevention of fellow eye involvement in NAION remain of unproven benefit.