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Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)

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Abstract

Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in older individuals and usually occurs in patients with vascular risk factors and a “disc at risk” (i.e., a small optic nerve head and an absent or small physiologic cup). Potential areas for intervention in NAION include correction of underlying risk factors, improving perfusion to the optic nerve, reducing the pressure at the level of the optic nerve head, and limiting axonal injury. There remains no established treatment for NAION and most studies are of low quality with high risk of bias. The only Class I large multicenter prospective treatment trial, the Ischemic Optic Neuropathy Decompression Trial (IONDT), found no benefit from surgical intervention. A large retrospective trial using oral prednisone found a statistically significant improvement in patients presenting with a visual acuity of 20/70 or worse compared to no treatment. However, this study should be interpreted with caution due to its methodological design flaws. Aspirin for secondary prevention also remains of unproven benefit, but is a reasonable option in patients with vascular risk factors since it is well-proven in the prevention of other ischemic events. Clinicians are encouraged to enroll their patients in well-constructed Class I clinical trials, when available, to facilitate the discovery and validation of effective therapies for NAION.

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Authors and Affiliations

  1. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada

    Jonathan A. Micieli

  2. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA

    Valérie Biousse & Nancy J. Newman

  3. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA

    Valérie Biousse & Nancy J. Newman

  4. Neuro-Ophthalmology Unit, Emory Eye Center, Atlanta, GA, USA

    Valérie Biousse & Nancy J. Newman

  5. Singapore National Eye Centre, Singapore Eye Research Institute and Duke-NUS, Singapore, Singapore

    Dan Milea

  6. Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Nancy J. Newman

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  1. Jonathan A. Micieli
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  2. Valérie Biousse
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  3. Dan Milea
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  4. Nancy J. Newman
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Correspondence to Nancy J. Newman .

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Editors and Affiliations

  1. Weill Cornell Medicine, Blanton Eye Institute Houston Methodist Hospital, Houston, TX, USA

    Andrew G. Lee

  2. Metabolic Neurology, Institute of Metabolism and Systems Research College of Medical & Dental Sciences University of Birmingham, Birmingham, UK

    Alexandra J. Sinclair

  3. Houston Methodist Hospital, Blanton Eye Institute, Houston, TX, USA

    Ama Sadaka

  4. Houston Methodist Hospital, Blanton Eye Institute, Houston, TX, USA

    Shauna Berry

  5. Birmingham Neuro-Ophthalmology, University Hospital Birmingham, Birmingham, UK

    Susan P. Mollan

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Micieli, J.A., Biousse, V., Milea, D., Newman, N.J. (2019). Treatment of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION). In: Lee, A., Sinclair, A., Sadaka, A., Berry, S., Mollan, S. (eds) Neuro-Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-98455-1_3

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