Journal article
Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful
JAMA : the journal of the American Medical Association, Vol.273(8), pp.625-632
02/22/1995
DOI: 10.1001/jama.1995.03520320035038
PMID: 7844872
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)
Details
- Title: Subtitle
- Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful
- Creators
- Kay DickersinJohn KennerdellSophia Chung - University of Iowa, NeurologyRussell EdwardsDonald EverettAnna TyutyunikovSonia ArmstrongTodd GoodglickPatricia JonesJohn SelhorstSteven Feldon - University of RochesterMark MaltonMichael GrahamYvonne McCrackenFrank HooperEugene BenjaminRichard AndersonCarol DellingerTraci Hunter MedlinDavid Kaufman - Michigan State UniversityCharlene CampbellBarbara KinslerShalom KelmanMike McOwenPatricia LangenbergDonna Russell - Iowa State UniversityNancy J NewmanTimothy SaundersP. David WilsonGregory KosmorskyDeborah LangTina KissZ. Suzanne ZamSusannah HansonKimberly PeeleCate ReinhardDiana MekelburgDeborah RossJohn HoldsNancy TomsakJanet EdgertonBrian KrausLaura De VenneTami FeckoPamela VargoRufus WillisKerry ZimmermanKristin AndersonRichard CortezKaren DeBlancJudy HulseRonald B MoralesTracy NicholsLillian ReyesNadine Rodarte-OchoaDaniel RomoAlfredo SadunMary SteberFrances WalonkerDonna LoupeDiana CoffmanHarvey ColeTed WojnoBarry SkarfColleen WojtalaMark CroswellWendy GilroyChristian MageliDena McDonaldGeorge PonkaRosa TangMelissa HamlinJewel CurtisJay Forman - Brigham and Women's HospitalKenneth HydeKirk MackBobbi BallenbergPortia TelloRobert Goldberg - University of California, Los AngelesAnne BoltonBerniee CibenerLynn GordonMichael HeneghanMelody AceroAnthony ArnoldHoward KraussJackie SanguineiRobert StallingJenja YadegaranWayne CornblathBarbara MichaelDonna CampbellCheryl CaudillChristine NelsonJonathan TrobeLenworth N JohnsonGaye BakerCoy CobbPhilip CusterSharon TurnerRoy WilsonBrian YoungeJacqueline LeavittRebecca NielsenJody AllenBarbara EickhoffJames GarrityJacqueline LadstenKathleen LeBarronThomas P LinkJay RostvoldKaren WeberWarren FeltonTracy BoneyDanielle GabrielDaniel DavidCraig MungerLahn FendelanderJo Anne RomandyDaniel GellerGeorge SanbornTimothy JordanBradley SchwartzChristian KimCarl SheusiConstance SmithKathy TalleySandya ThimmappaEric Eggenberger - Michigan State UniversitySuzanne BickertRobert Granadier - Beaumont Hospital, Royal OakSandra HollidayThomas MooreJaya VaradarajanDeborah Friedman - The University of Texas Southwestern Medical CenterHaris AminThomas BersaniCynthia BriglinJames FooksMilton JamesGary MichalecHoang NguyenJonathan HortonMaeve ChangLou Anne AberErik LindstromStuart SeiffJohn GuyAmye FrancisLatif HamedAlan LessnerDonna McDavidDiana ShamisJames GoodwinMartin E LindemanAllen PuttermanPhyllis BobakRobert BakerJudy BeckDavid CowenAvrom EpsteinMichael HansonToni ScogginsAnn M RodavitchBrenda GoreAndrea BlakeMichele HerouxRani KalsiCharlene KrauchMary Ann MillarMitchell WolinRita Jean BradyRegina HansenMichael BriggsKarkarla V ChalamBarbara DannerBeverly SimonsAnne StewartKathleen Digre - University of UtahTerrell BlackburnLizbeth Malmquist-WebbSusan BaggaleyCharles JuarezBonnie KayePaul LangerAditya MishraPaula MorrisSandra OsbornBhupendra PatelTessie PriskosSandra StakerJudith WarnerSteven NewmanChristine EvansAllison AylorCarolyn ChildressHelen DickersonJane FlemingNomine HarrisL. Sharon HoyleEllen MurphyJames Scott - University of Oklahoma Health Sciences CenterKaren SummervilleMariann TerrellLillian TylerJohn LinbergLenore BreenMichelle MichaelBrian EllisNancy GrovesRobert HobsonGordon McGregorLaura ShepherdEdward CohnPatricia ManatreySara CaseyJohn JohnsonColetti KronnerVirginia ReganPatricia StreasickMichael ElmanAim M RodavitchRoberta SchererBarbara CrawleyCheryl HinerLucy HowardOlga LuryeRobert McCarterSara RiedelMichelle SotosLaureen SpiochJoann StarrJudy UrbanMark Waring
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.273(8), pp.625-632
- DOI
- 10.1001/jama.1995.03520320035038
- PMID
- 7844872
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Publisher
- American Medical Association
- Language
- English
- Date published
- 02/22/1995
- Academic Unit
- Neurology; Ophthalmology and Visual Sciences
- Record Identifier
- 9984111210302771
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