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Characteristics of Patients With Nonarteritic Anterior Ischemic Optic Neuropathy Eligible for the Ischemic Optic Neuropathy Decompression Trial

Characteristics of Patients With Nonarteritic Anterior Ischemic Optic Neuropathy Eligible for the... Abstract Objective: To describe the baseline clinical characteristics of patients in the Ischemic Optic Neuropathy Decompression Trial (IONDT). Design: The IONDT is a single-masked, multicenter, randomized clinical trial. Settings: Twenty-five US clinical centers. Patients: Eligibility criteria for randomization to either optic nerve sheath decompression surgery or careful follow-up included a diagnosis of acute unilateral nonarteritic anterior ischemic optic neuropathy (NAION), a visual acuity of 20/64 or worse and better than no light perception, and an age of 50 years or older. Patients who were eligible except for having visual acuity better than 20/64 were not randomized, but were followed up. Methods: Each patient underwent a standardized history and examination by certified study personnel within 14 days of the onset of symptoms. Masked personnel performed outcome measurements. Results: Of 420 patients with NAION, 258 were randomized, and 162 were not randomized and are being followed up. Sixty-two percent of the patients were men and 95% were white. The mean±SD age at onset was 66.0±8.7 years. Hypertension was reported in 47% of the patients in the IONDT, and 24% of the patients had diabetes mellitus. Forty-two percent of the patients recalled the onset of visual symptoms to be within 2 hours of awakening. Initial visual acuities in the study eye ranged from 20/20 or better to light perception, with 49% of the patients seeing better than 20/64 and 34% of the patients seeing 20/200 or worse. The mean Westergren sedimentation rate was 18.4 mm/h, with 9% of the patients having a rate greater than 40 mm/h. The nonrandomized patients (visual acuity better than 20/64) were younger, 72% were male, and they had a lower prevalence of hypertension and diabetes mellitus. Conclusion: Although our baseline findings are derived from a selected population of patients with NAION who were eligible for the IONDT, they provide the first description of NAION from a large prospective study that used a standard definition of NAION and only included patients who were identified within 2 weeks of the onset of symptoms. References 1. Hayreh SS. Anterior ischemic optic neuropathy . Arch Neurol . 1981;38:675-678.Crossref 2. Hayreh SS. Anterior Ischemic Optic Neuropathy . New York, NY: Springer-Verlag NY Inc; 1975. 3. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy . Am J Ophthalmol . 1994;118:766-780. 4. Hayreh SS. Anterior ischaemic optic neuropathy: differentiation of arteritic from non-arteritic type and its management . Eye . 1990;4:25-41.Crossref 5. Moro F, Doro D, Mantovani E. Anterior ischemic optic neuropathy and aging . Metab Pediatr Syst Ophthalmol . 1989;12:46-57. 6. Johnson LN, Arnold AC. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy: population-based study in the state of Missouri and Los Angeles County, California . J Neuroophthalmol . 1994;14:38-44.Crossref 7. Ischemic Optic Neuropathy Decompression Trial (IONDT) Research Group. Manual of Operations . Baltimore, Md: University of Maryland at Baltimore; 1992:chap 1:1-29. 8. Kelman SE. The Ischemic Optic Neuropathy Decompression Trial . Arch Ophthalmol . 1993;111:1616-1618.Crossref 9. Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful . JAMA . 1995;273:625-632.Crossref 10. Hayreh SS, Podhajsky P. Visual field defects in anterior ischemic optic neuropathy . Doc Ophthalmol Proc Ser . 1979;19:53-71. 11. Repka MX, Savino PJ, Schatz NJ, Sergott RC. Clinical profile and long-term implications of anterior ischemic optic neuropathy . Am J Ophthalmol . 1983;96:478-483. 12. Sawle GV, James CB, Ross Russell RW. The natural history of non-arteritic anterior ischaemic optic neuropathy . J Neurol Neurosurg Psychiatry . 1990;53:830-833.Crossref 13. Rizzo JF, Lessell S. Optic neuritis and ischemic optic neuropathy: overlapping clinical profiles . Arch Ophthalmol . 1991;109:1668-1672.Crossref 14. Foulds WS. Visual disturbances in systemic disorders: optic neuropathy and systemic disease . Eye . 1969;89:125-146. 15. Ellenberger C Jr, Keltner JL, Burde RM. Acute optic neuropathy in older patients . Arch Neurol . 1973;28:182-185.Crossref 16. Eagling EM, Sanders MD, Miller SJH. Ischaemic papillopathy: clinical and fluorescein angiographic review of forty cases . Br J Ophthalmol . 1974;58:990-1008.Crossref 17. Boghen DR, Glaser JS. Ischaemic optic neuropathy: the clinical profile and history . Brain . 1975;98:689-708.Crossref 18. Guyer DR, Miller NR, Auer CL, Fine SL. The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy . Arch Ophthalmol . 1985;103:1136-1142.Crossref 19. Giuffre G. Hematological risk factors for anterior ischemic optic neuropathy . Neuro-ophthalmology . 1990;10:197-203.Crossref 20. Chung SM, Gay CA, McCrary JA. Nonarteritic ischemic optic neuropathy: the impact of tobacco use . Ophthalmology . 1994;101:779-782.Crossref 21. Johnson LN, Botelho PJ, Kuo HC. Is smoking a risk factor for NAION? Ophthalmology . 1994;101:1322-1324.Crossref 22. Chi T, Ritch R, Stickler D, Pitman B, Tsai C, Hsieh FY. Racial differences in optic nerve head parameters . Arch Ophthalmol . 1989;107:836-839.Crossref 23. Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neuropathy, IX: cup-to-disc ratio and its role in pathogenesis . Ophthalmology . 1987;94:1503-1508.Crossref 24. Thompson PD, Mastaglia FL, Carroll WM. Anterior ischaemic optic neuropathy: a correlative clinical and visual evoked potential study of 18 patients . J Neurol Neurosurg Psychiatry . 1986;49:128-135.Crossref 25. Swartz NG, Beck RW, Savino PJ, et al. Pain in anterior ischemic optic neuropathy . J Neuroophthalmol . 1995;15:9-10.Crossref 26. Arnold AC, Hepler RS. Natural history of nonarteritic anterior ischemic optic neuropathy . J Neuroophthalmol . 1994;14:66-69.Crossref 27. Beri M, Klugman MR, Kohler JA, Hayreh SS. Anterior ischemic optic neuropathy, VII: incidence of bilaterality and various influencing factors . Ophthalmology . 1987;94:1020-1028.Crossref 28. Hayreh SS, Zimmerman BM, Podhajsky P, Alward WLM. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders . Am J Ophthalmol . 1994;117:603-624. 29. Lieberman MF, Shahi A, Green WR. Embolic ischemic optic neuropathy . Am J Ophthalmol . 1978;86:206-210. 30. Wolf PA, Cobb JL, D'Agostino RB. Epidemiology of stroke . In: Barnett HJ, Mohr JP, Stein BM, Yatsu FM, eds. Stroke: Pathophysiology, Diagnosis, and Management . New York, NY: Churchill Livingstone Inc; 1992:3-27. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Characteristics of Patients With Nonarteritic Anterior Ischemic Optic Neuropathy Eligible for the Ischemic Optic Neuropathy Decompression Trial

Archives of Ophthalmology , Volume 114 (11) – Nov 1, 1996
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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1996.01100140566007
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Abstract

Abstract Objective: To describe the baseline clinical characteristics of patients in the Ischemic Optic Neuropathy Decompression Trial (IONDT). Design: The IONDT is a single-masked, multicenter, randomized clinical trial. Settings: Twenty-five US clinical centers. Patients: Eligibility criteria for randomization to either optic nerve sheath decompression surgery or careful follow-up included a diagnosis of acute unilateral nonarteritic anterior ischemic optic neuropathy (NAION), a visual acuity of 20/64 or worse and better than no light perception, and an age of 50 years or older. Patients who were eligible except for having visual acuity better than 20/64 were not randomized, but were followed up. Methods: Each patient underwent a standardized history and examination by certified study personnel within 14 days of the onset of symptoms. Masked personnel performed outcome measurements. Results: Of 420 patients with NAION, 258 were randomized, and 162 were not randomized and are being followed up. Sixty-two percent of the patients were men and 95% were white. The mean±SD age at onset was 66.0±8.7 years. Hypertension was reported in 47% of the patients in the IONDT, and 24% of the patients had diabetes mellitus. Forty-two percent of the patients recalled the onset of visual symptoms to be within 2 hours of awakening. Initial visual acuities in the study eye ranged from 20/20 or better to light perception, with 49% of the patients seeing better than 20/64 and 34% of the patients seeing 20/200 or worse. The mean Westergren sedimentation rate was 18.4 mm/h, with 9% of the patients having a rate greater than 40 mm/h. The nonrandomized patients (visual acuity better than 20/64) were younger, 72% were male, and they had a lower prevalence of hypertension and diabetes mellitus. Conclusion: Although our baseline findings are derived from a selected population of patients with NAION who were eligible for the IONDT, they provide the first description of NAION from a large prospective study that used a standard definition of NAION and only included patients who were identified within 2 weeks of the onset of symptoms. References 1. Hayreh SS. Anterior ischemic optic neuropathy . Arch Neurol . 1981;38:675-678.Crossref 2. Hayreh SS. Anterior Ischemic Optic Neuropathy . New York, NY: Springer-Verlag NY Inc; 1975. 3. Hayreh SS, Joos KM, Podhajsky PA, Long CR. Systemic diseases associated with nonarteritic anterior ischemic optic neuropathy . Am J Ophthalmol . 1994;118:766-780. 4. Hayreh SS. Anterior ischaemic optic neuropathy: differentiation of arteritic from non-arteritic type and its management . Eye . 1990;4:25-41.Crossref 5. Moro F, Doro D, Mantovani E. Anterior ischemic optic neuropathy and aging . Metab Pediatr Syst Ophthalmol . 1989;12:46-57. 6. Johnson LN, Arnold AC. Incidence of nonarteritic and arteritic anterior ischemic optic neuropathy: population-based study in the state of Missouri and Los Angeles County, California . J Neuroophthalmol . 1994;14:38-44.Crossref 7. Ischemic Optic Neuropathy Decompression Trial (IONDT) Research Group. Manual of Operations . Baltimore, Md: University of Maryland at Baltimore; 1992:chap 1:1-29. 8. Kelman SE. The Ischemic Optic Neuropathy Decompression Trial . Arch Ophthalmol . 1993;111:1616-1618.Crossref 9. Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful . JAMA . 1995;273:625-632.Crossref 10. Hayreh SS, Podhajsky P. Visual field defects in anterior ischemic optic neuropathy . Doc Ophthalmol Proc Ser . 1979;19:53-71. 11. Repka MX, Savino PJ, Schatz NJ, Sergott RC. Clinical profile and long-term implications of anterior ischemic optic neuropathy . Am J Ophthalmol . 1983;96:478-483. 12. Sawle GV, James CB, Ross Russell RW. The natural history of non-arteritic anterior ischaemic optic neuropathy . J Neurol Neurosurg Psychiatry . 1990;53:830-833.Crossref 13. Rizzo JF, Lessell S. Optic neuritis and ischemic optic neuropathy: overlapping clinical profiles . Arch Ophthalmol . 1991;109:1668-1672.Crossref 14. Foulds WS. Visual disturbances in systemic disorders: optic neuropathy and systemic disease . Eye . 1969;89:125-146. 15. Ellenberger C Jr, Keltner JL, Burde RM. Acute optic neuropathy in older patients . Arch Neurol . 1973;28:182-185.Crossref 16. Eagling EM, Sanders MD, Miller SJH. Ischaemic papillopathy: clinical and fluorescein angiographic review of forty cases . Br J Ophthalmol . 1974;58:990-1008.Crossref 17. Boghen DR, Glaser JS. Ischaemic optic neuropathy: the clinical profile and history . Brain . 1975;98:689-708.Crossref 18. Guyer DR, Miller NR, Auer CL, Fine SL. The risk of cerebrovascular and cardiovascular disease in patients with anterior ischemic optic neuropathy . Arch Ophthalmol . 1985;103:1136-1142.Crossref 19. Giuffre G. Hematological risk factors for anterior ischemic optic neuropathy . Neuro-ophthalmology . 1990;10:197-203.Crossref 20. Chung SM, Gay CA, McCrary JA. Nonarteritic ischemic optic neuropathy: the impact of tobacco use . Ophthalmology . 1994;101:779-782.Crossref 21. Johnson LN, Botelho PJ, Kuo HC. Is smoking a risk factor for NAION? Ophthalmology . 1994;101:1322-1324.Crossref 22. Chi T, Ritch R, Stickler D, Pitman B, Tsai C, Hsieh FY. Racial differences in optic nerve head parameters . Arch Ophthalmol . 1989;107:836-839.Crossref 23. Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neuropathy, IX: cup-to-disc ratio and its role in pathogenesis . Ophthalmology . 1987;94:1503-1508.Crossref 24. Thompson PD, Mastaglia FL, Carroll WM. Anterior ischaemic optic neuropathy: a correlative clinical and visual evoked potential study of 18 patients . J Neurol Neurosurg Psychiatry . 1986;49:128-135.Crossref 25. Swartz NG, Beck RW, Savino PJ, et al. Pain in anterior ischemic optic neuropathy . J Neuroophthalmol . 1995;15:9-10.Crossref 26. Arnold AC, Hepler RS. Natural history of nonarteritic anterior ischemic optic neuropathy . J Neuroophthalmol . 1994;14:66-69.Crossref 27. Beri M, Klugman MR, Kohler JA, Hayreh SS. Anterior ischemic optic neuropathy, VII: incidence of bilaterality and various influencing factors . Ophthalmology . 1987;94:1020-1028.Crossref 28. Hayreh SS, Zimmerman BM, Podhajsky P, Alward WLM. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders . Am J Ophthalmol . 1994;117:603-624. 29. Lieberman MF, Shahi A, Green WR. Embolic ischemic optic neuropathy . Am J Ophthalmol . 1978;86:206-210. 30. Wolf PA, Cobb JL, D'Agostino RB. Epidemiology of stroke . In: Barnett HJ, Mohr JP, Stein BM, Yatsu FM, eds. Stroke: Pathophysiology, Diagnosis, and Management . New York, NY: Churchill Livingstone Inc; 1992:3-27.

Journal

Archives of Ophthalmology – American Medical Association

Published: Nov 1, 1996

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