Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful

Frank Ischemic; Frank Hooper; David Kaufman; Nancy J. Newman; P. David Wilson; Z. Suzanne Zam; John Kennerdell; Anna Tyutyunikov; Russell Edwards; Todd Goodglick; Deborah Lang; Kimberly Peele; Sophia Chung; Diana Mekelburg; John Holds; John Selhorst; Mark Malton; Sonia Armstrong; Yvonne Mccracken; Eugene Benjamin; Carol Dellinger; Traci Hunter Medlin; Barbara Kinsler; Mike Mcowen; Donna Russell; Timothy Saunders; Gregory Kosmorsky; Tina Kiss; Cate Reinhard; Laura Venne; Janet Edgerton; Tami Fecko; Susannah Hanson; Brian Kraus; Deborah Ross; Nancy Tomsak; Pamela Vargo; Rufus Willis; Steven Feldon; Kerry Zimmerman; Kristin Anderson; Richard Cortez; Karen Deblanc; Judy Hulse; Ronald B. Morales; Tracy Nichols; Lillian Reyes; Nadine Rodarte Ochoa; Daniel Romo; Alfredo Sadun; Mary Steber; Frances Walonker; Donna Loupe; Diana Coffman; Harvey Cole; Ted Wojno; Barry Skarf; Colleen Wojtala; Mark Croswell; Wendy Gilroy; Christian Mageli; Dena Mcdonald; George Ponka; Rosa Tang; Melissa Hamlin; Jewel Curtis; Jay Forman; Kenneth Hyde; Kirk Mack; Portia Tello; Anthony Arnold; Berniee Cibener; Melody Acero; Bobbi Ballenberg; Anne Bolton; Robert Goldberg; Lynn Gordon; Michael Heneghan; Howard Krauss; Jackie Sanguinei; Robert Stalling; Jenja Yadegaran; Wayne Cornblath; Barbara Michael; Donna Campbell; Cheryl Caudill; Christine Nelson; Jonathan Trobe; Lenworth N. Johnson; Gaye Baker; Coy Cobb; Philip Custer; Sharon Turner; Roy Wilson; Brian Younge; Jacqueline Leavitt; Rebecca Nielsen; Jody Allen; Barbara Eickhoff; James Garrity; Jacqueline Ladsten; Kathleen Lebarron; Thomas P. Link; Jay Rostvold; Karen Weber; Warren Felton; Tracy Boney; Danielle Gabriel; Daniel David; Lahn Fendelander; Daniel Geller; Timothy Jordan; Christian Kim; Craig Munger; Anne Romandy; George Sanborn; Bradley Schwartz; Carl Sheusi; Constance Smith; Kathy Talley; Sandya Thimmappa; Eric Eggenberger; Suzanne Bickert; Robert Granadier; Sandra Holliday; Thomas Moore; Jaya Varadarajan; Deborah Friedman; Patricia Jones; Haris Amin; Thomas Bersani; Cynthia Briglin; James Fooks; Michael Graham; Milton James; Gary Michalec; Hoang Nguyen; Jonathan Horton; Maeve Chang; Lou Anne Aber; Erik Lindstrom; Stuart Seiff; John Guy; Amye Francis; Latif Hamed; Alan Lessner; Donna Mcdavid; Diana Shamis; James Goodwin; Martin E. Lindeman; Allen Putterman; Phyllis Bobak; Robert Baker; Judy Beck; David Cowen; Avrom Epstein; Michael 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 Digre; Lizbeth Malmquist Webb; Terrell Blackburn; Susan Baggaley; Richard Anderson; Charles Juarez; Bonnie Kaye; Paul Langer; Aditya Mishra; Paula Morris; Sandra Osborn; Bhupendra Patel; Tessie Priskos; Sandra Staker; Judith 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 Linberg; Lenore Breen; Michelle Michael; Charlene Campbell; Brian Ellis; Nancy Groves; Robert Hobson; Gordon Mcgregor; Laura Shepherd; Edward Cohn; Patricia Manatrey; Sara Casey; John Johnson; Coletti Kronner; Virginia Regan; Patricia Streasick; Shalom Kelman; Michael Elman; Aim M. Rodavitch; Roberta 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

doi:10.1001/jama.273.8.625

Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful

Frank Ischemic, Frank Hooper, David Kaufman, Nancy J. Newman, P. David Wilson, Z. Suzanne Zam, John Kennerdell, Anna Tyutyunikov, Russell Edwards, Todd Goodglick, Deborah Lang, Kimberly Peele, Sophia Chung, Diana Mekelburg, John Holds, John Selhorst, Mark Malton, Sonia Armstrong, Yvonne Mccracken, Eugene BenjaminCarol Dellinger, Traci Hunter Medlin, Barbara Kinsler, Mike Mcowen, Donna Russell, Timothy Saunders, Gregory Kosmorsky, Tina Kiss, Cate Reinhard, Laura Venne, Janet Edgerton, Tami Fecko, Susannah Hanson, Brian Kraus, Deborah Ross, Nancy Tomsak, Pamela Vargo, Rufus Willis, Steven Feldon, Kerry Zimmerman, Kristin Anderson, Richard Cortez, Karen Deblanc, Judy Hulse, Ronald B. Morales, Tracy Nichols, Lillian Reyes, Nadine Rodarte Ochoa, Daniel Romo, Alfredo Sadun, Mary Steber, Frances Walonker, Donna Loupe, Diana Coffman, Harvey Cole, Ted Wojno, Barry Skarf, Colleen Wojtala, Mark Croswell, Wendy Gilroy, Christian Mageli, Dena Mcdonald, George Ponka, Rosa Tang, Melissa Hamlin, Jewel Curtis, Jay Forman, Kenneth Hyde, Kirk Mack, Portia Tello, Anthony Arnold, Berniee Cibener, Melody Acero, Bobbi Ballenberg, Anne Bolton, Robert Goldberg, Lynn Gordon, Michael Heneghan, Howard Krauss, Jackie Sanguinei, Robert Stalling, Jenja Yadegaran, Wayne Cornblath, Barbara Michael, Donna Campbell, Cheryl Caudill, Christine Nelson, Jonathan Trobe, Lenworth N. Johnson, Gaye Baker, Coy Cobb, Philip Custer, Sharon Turner, Roy Wilson, Brian Younge, Jacqueline Leavitt, Rebecca Nielsen, Jody Allen, Barbara Eickhoff, James Garrity, Jacqueline Ladsten, Kathleen Lebarron, Thomas P. Link, Jay Rostvold, Karen Weber, Warren Felton, Tracy Boney, Danielle Gabriel, Daniel David, Lahn Fendelander, Daniel Geller, Timothy Jordan, Christian Kim, Craig Munger, Anne Romandy, George Sanborn, Bradley Schwartz, Carl Sheusi, Constance Smith, Kathy Talley, Sandya Thimmappa, Eric Eggenberger, Suzanne Bickert, Robert Granadier, Sandra Holliday, Thomas Moore, Jaya Varadarajan, Deborah Friedman, Patricia Jones, Haris Amin, Thomas Bersani, Cynthia Briglin, James Fooks, Michael Graham, Milton James, Gary Michalec, Hoang Nguyen, Jonathan Horton, Maeve Chang, Lou Anne Aber, Erik Lindstrom, Stuart Seiff, John Guy, Amye Francis, Latif Hamed, Alan Lessner, Donna Mcdavid, Diana Shamis, James Goodwin, Martin E. Lindeman, Allen Putterman, Phyllis Bobak, Robert Baker, Judy Beck, David Cowen, Avrom Epstein, Michael 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 Digre, Lizbeth Malmquist Webb, Terrell Blackburn, Susan Baggaley, Richard Anderson, Charles Juarez, Bonnie Kaye, Paul Langer, Aditya Mishra, Paula Morris, Sandra Osborn, Bhupendra Patel, Tessie Priskos, Sandra Staker, Judith 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 Linberg, Lenore Breen, Michelle Michael, Charlene Campbell, Brian Ellis, Nancy Groves, Robert Hobson, Gordon Mcgregor, Laura Shepherd, Edward Cohn, Patricia Manatrey, Sara Casey, John Johnson, Coletti Kronner, Virginia Regan, Patricia Streasick, Shalom Kelman, Michael Elman, Aim M. Rodavitch, Roberta 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

Research output: Contribution to journal › Article › peer-review

356 Scopus citations

Abstract

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). —The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. —Twenty-five US clinical centers. —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. —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. —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. —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. —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.

Original language	English (US)
Pages (from-to)	625-632
Number of pages	8
Journal	JAMA: The Journal of the American Medical Association
Volume	273
Issue number	8
DOIs	https://doi.org/10.1001/jama.273.8.625
State	Published - Feb 1995
Externally published	Yes

ASJC Scopus subject areas

Medicine(all)

Access to Document

10.1001/jama.273.8.625

Cite this

Ischemic, F., Hooper, F., Kaufman, D., Newman, N. J., Wilson, P. D., Zam, Z. S., Kennerdell, J., Tyutyunikov, A., Edwards, R., Goodglick, T., Lang, D., Peele, K., Chung, S., Mekelburg, D., Holds, J., Selhorst, J., Malton, M., Armstrong, S., Mccracken, Y., ... Seiff, S. R. (1995). 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, 273(8), 625-632. https://doi.org/10.1001/jama.273.8.625

Ischemic, F, Hooper, F, Kaufman, D, Newman, NJ, Wilson, PD, Zam, ZS, Kennerdell, J, Tyutyunikov, A, Edwards, R, Goodglick, T, Lang, D, Peele, K, Chung, S, Mekelburg, D, Holds, J, Selhorst, J, Malton, M, Armstrong, S, Mccracken, Y, Benjamin, E, Dellinger, C, Medlin, TH, Kinsler, B, Mcowen, M, Russell, D, Saunders, T, Kosmorsky, G, Kiss, T, Reinhard, C, Venne, L, Edgerton, J, Fecko, T, Hanson, S, Kraus, B, Ross, D, Tomsak, N, Vargo, P, Willis, R, Feldon, S, Zimmerman, K, Anderson, K, Cortez, R, Deblanc, K, Hulse, J, Morales, RB, Nichols, T, Reyes, L, Rodarte Ochoa, N, Romo, D, Sadun, A, Steber, M, Walonker, F, Loupe, D, Coffman, D, Cole, H, Wojno, T, Skarf, B, Wojtala, C, Croswell, M, Gilroy, W, Mageli, C, Mcdonald, D, Ponka, G, Tang, R, Hamlin, M, Curtis, J, Forman, J, Hyde, K, Mack, K, Tello, P, Arnold, A, Cibener, B, Acero, M, Ballenberg, B, Bolton, A, Goldberg, R, Gordon, L, Heneghan, M, Krauss, H, Sanguinei, J, Stalling, R, Yadegaran, J, Cornblath, W, Michael, B, Campbell, D, Caudill, C, Nelson, C, Trobe, J, Johnson, LN, Baker, G, Cobb, C, Custer, P, Turner, S, Wilson, R, Younge, B, Leavitt, J, Nielsen, R, Allen, J, Eickhoff, B, Garrity, J, Ladsten, J, Lebarron, K, Link, TP, Rostvold, J, Weber, K, Felton, W, Boney, T, Gabriel, D, David, D, Fendelander, L, Geller, D, Jordan, T, Kim, C, Munger, C, Romandy, A, Sanborn, G, Schwartz, B, Sheusi, C, Smith, C, Talley, K, Thimmappa, S, Eggenberger, E, Bickert, S, Granadier, R, Holliday, S, Moore, T, Varadarajan, J, Friedman, D, Jones, P, Amin, H, Bersani, T, Briglin, C, Fooks, J, Graham, M, James, M, Michalec, G, Nguyen, H, Horton, J, Chang, M, Aber, LA, Lindstrom, E, Seiff, S, Guy, J, Francis, A, Hamed, L, Lessner, A, Mcdavid, D, Shamis, D, Goodwin, J, Lindeman, ME, Putterman, A, Bobak, P, Baker, R, Beck, J, Cowen, D, Epstein, A, Hanson, M, Scoggins, T, Rodavitch, AM, Gore, B, Blake, A, Heroux, M, Kalsi, R, Krauch, C, Millar, MA, Wolin, M, Brady, RJ, Hansen, R, Briggs, M, Chalam, KV, Danner, B, Simons, B, Stewart, A, Digre, K, Malmquist Webb, L, Blackburn, T, Baggaley, S, Anderson, R, Juarez, C, Kaye, B, Langer, P, Mishra, A, Morris, P, Osborn, S, Patel, B, Priskos, T, Staker, S, Warner, J, Evans, C, Aylor, A, Childress, C, Dickerson, H, Fleming, J, Harris, N, Hoyle, LS, Murphy, E, Scott, J, Summerville, K, Terrell, M, Tyler, L, Linberg, J, Breen, L, Michael, M, Campbell, C, Ellis, B, Groves, N, Hobson, R, Mcgregor, G, Shepherd, L, Cohn, E, Manatrey, P, Casey, S, Johnson, J, Kronner, C, Regan, V, Streasick, P, Kelman, S, Elman, M, Rodavitch, AM, Scherer, R, Crawley, B, Hiner, C, Howard, L, Langenberg, P, Lurye, O, Riedel, S, Sotos, M, Spioch, L, Starr, J, Urban, J, Waring, M, Everett, D, Dickersin, K, Mccarter, R & Seiff, SR 1995, '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, no. 8, pp. 625-632. https://doi.org/10.1001/jama.273.8.625

@article{07c02719e8244ef48603ab19e5d8612c,

title = "Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful",

abstract = "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). —The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. —Twenty-five US clinical centers. —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. —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. —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. —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. —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.",

author = "Frank Ischemic and Frank Hooper and David Kaufman and Newman, {Nancy J.} and Wilson, {P. David} and Zam, {Z. Suzanne} and John Kennerdell and Anna Tyutyunikov and Russell Edwards and Todd Goodglick and Deborah Lang and Kimberly Peele and Sophia Chung and Diana Mekelburg and John Holds and John Selhorst and Mark Malton and Sonia Armstrong and Yvonne Mccracken and Eugene Benjamin and Carol Dellinger and Medlin, {Traci Hunter} and Barbara Kinsler and Mike Mcowen and Donna Russell and Timothy Saunders and Gregory Kosmorsky and Tina Kiss and Cate Reinhard and Laura Venne and Janet Edgerton and Tami Fecko and Susannah Hanson and Brian Kraus and Deborah Ross and Nancy Tomsak and Pamela Vargo and Rufus Willis and Steven Feldon and Kerry Zimmerman and Kristin Anderson and Richard Cortez and Karen Deblanc and Judy Hulse and Morales, {Ronald B.} and Tracy Nichols and Lillian Reyes and {Rodarte Ochoa}, Nadine and Daniel Romo and Alfredo Sadun and Mary Steber and Frances Walonker and Donna Loupe and Diana Coffman and Harvey Cole and Ted Wojno and Barry Skarf and Colleen Wojtala and Mark Croswell and Wendy Gilroy and Christian Mageli and Dena Mcdonald and George Ponka and Rosa Tang and Melissa Hamlin and Jewel Curtis and Jay Forman and Kenneth Hyde and Kirk Mack and Portia Tello and Anthony Arnold and Berniee Cibener and Melody Acero and Bobbi Ballenberg and Anne Bolton and Robert Goldberg and Lynn Gordon and Michael Heneghan and Howard Krauss and Jackie Sanguinei and Robert Stalling and Jenja Yadegaran and Wayne Cornblath and Barbara Michael and Donna Campbell and Cheryl Caudill and Christine Nelson and Jonathan Trobe and Johnson, {Lenworth N.} and Gaye Baker and Coy Cobb and Philip Custer and Sharon Turner and Roy Wilson and Brian Younge and Jacqueline Leavitt and Rebecca Nielsen and Jody Allen and Barbara Eickhoff and James Garrity and Jacqueline Ladsten and Kathleen Lebarron and Link, {Thomas P.} and Jay Rostvold and Karen Weber and Warren Felton and Tracy Boney and Danielle Gabriel and Daniel David and Lahn Fendelander and Daniel Geller and Timothy Jordan and Christian Kim and Craig Munger and Anne Romandy and George Sanborn and Bradley Schwartz and Carl Sheusi and Constance Smith and Kathy Talley and Sandya Thimmappa and Eric Eggenberger and Suzanne Bickert and Robert Granadier and Sandra Holliday and Thomas Moore and Jaya Varadarajan and Deborah Friedman and Patricia Jones and Haris Amin and Thomas Bersani and Cynthia Briglin and James Fooks and Michael Graham and Milton James and Gary Michalec and Hoang Nguyen and Jonathan Horton and Maeve Chang and Aber, {Lou Anne} and Erik Lindstrom and Stuart Seiff and John Guy and Amye Francis and Latif Hamed and Alan Lessner and Donna Mcdavid and Diana Shamis and James Goodwin and Lindeman, {Martin E.} and Allen Putterman and Phyllis Bobak and Robert Baker and Judy Beck and David Cowen and Avrom Epstein and Michael Hanson and Toni Scoggins and Rodavitch, {Ann M.} and Brenda Gore and Andrea Blake and Michele Heroux and Rani Kalsi and Charlene Krauch and Millar, {Mary Ann} and Mitchell Wolin and Brady, {Rita Jean} and Regina Hansen and Michael Briggs and Chalam, {Karkarla V.} and Barbara Danner and Beverly Simons and Anne Stewart and Kathleen Digre and {Malmquist Webb}, Lizbeth and Terrell Blackburn and Susan Baggaley and Richard Anderson and Charles Juarez and Bonnie Kaye and Paul Langer and Aditya Mishra and Paula Morris and Sandra Osborn and Bhupendra Patel and Tessie Priskos and Sandra Staker and Judith Warner and Christine Evans and Allison Aylor and Carolyn Childress and Helen Dickerson and Jane Fleming and Nomine Harris and Hoyle, {L. Sharon} and Ellen Murphy and James Scott and Karen Summerville and Mariann Terrell and Lillian Tyler and John Linberg and Lenore Breen and Michelle Michael and Charlene Campbell and Brian Ellis and Nancy Groves and Robert Hobson and Gordon Mcgregor and Laura Shepherd and Edward Cohn and Patricia Manatrey and Sara Casey and John Johnson and Coletti Kronner and Virginia Regan and Patricia Streasick and Shalom Kelman and Michael Elman and Rodavitch, {Aim M.} and Roberta Scherer and Barbara Crawley and Cheryl Hiner and Lucy Howard and Patricia Langenberg and Olga Lurye and Sara Riedel and Michelle Sotos and Laureen Spioch and Joann Starr and Judy Urban and Mark Waring and Donald Everett and Kay Dickersin and Robert Mccarter and Seiff, {Stuart R.}",

year = "1995",

month = feb,

doi = "10.1001/jama.273.8.625",

language = "English (US)",

volume = "273",

pages = "625--632",

journal = "JAMA - Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

number = "8",

}

TY - JOUR

T1 - Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful

AU - Ischemic, Frank

AU - Hooper, Frank

AU - Kaufman, David

AU - Newman, Nancy J.

AU - Wilson, P. David

AU - Zam, Z. Suzanne

AU - Kennerdell, John

AU - Tyutyunikov, Anna

AU - Edwards, Russell

AU - Goodglick, Todd

AU - Lang, Deborah

AU - Peele, Kimberly

AU - Chung, Sophia

AU - Mekelburg, Diana

AU - Holds, John

AU - Selhorst, John

AU - Malton, Mark

AU - Armstrong, Sonia

AU - Mccracken, Yvonne

AU - Benjamin, Eugene

AU - Dellinger, Carol

AU - Medlin, Traci Hunter

AU - Kinsler, Barbara

AU - Mcowen, Mike

AU - Russell, Donna

AU - Saunders, Timothy

AU - Kosmorsky, Gregory

AU - Kiss, Tina

AU - Reinhard, Cate

AU - Venne, Laura

AU - Edgerton, Janet

AU - Fecko, Tami

AU - Hanson, Susannah

AU - Kraus, Brian

AU - Ross, Deborah

AU - Tomsak, Nancy

AU - Vargo, Pamela

AU - Willis, Rufus

AU - Feldon, Steven

AU - Zimmerman, Kerry

AU - Anderson, Kristin

AU - Cortez, Richard

AU - Deblanc, Karen

AU - Hulse, Judy

AU - Morales, Ronald B.

AU - Nichols, Tracy

AU - Reyes, Lillian

AU - Rodarte Ochoa, Nadine

AU - Romo, Daniel

AU - Sadun, Alfredo

AU - Steber, Mary

AU - Walonker, Frances

AU - Loupe, Donna

AU - Coffman, Diana

AU - Cole, Harvey

AU - Wojno, Ted

AU - Skarf, Barry

AU - Wojtala, Colleen

AU - Croswell, Mark

AU - Gilroy, Wendy

AU - Mageli, Christian

AU - Mcdonald, Dena

AU - Ponka, George

AU - Tang, Rosa

AU - Hamlin, Melissa

AU - Curtis, Jewel

AU - Forman, Jay

AU - Hyde, Kenneth

AU - Mack, Kirk

AU - Tello, Portia

AU - Arnold, Anthony

AU - Cibener, Berniee

AU - Acero, Melody

AU - Ballenberg, Bobbi

AU - Bolton, Anne

AU - Goldberg, Robert

AU - Gordon, Lynn

AU - Heneghan, Michael

AU - Krauss, Howard

AU - Sanguinei, Jackie

AU - Stalling, Robert

AU - Yadegaran, Jenja

AU - Cornblath, Wayne

AU - Michael, Barbara

AU - Campbell, Donna

AU - Caudill, Cheryl

AU - Nelson, Christine

AU - Trobe, Jonathan

AU - Johnson, Lenworth N.

AU - Baker, Gaye

AU - Cobb, Coy

AU - Custer, Philip

AU - Turner, Sharon

AU - Wilson, Roy

AU - Younge, Brian

AU - Leavitt, Jacqueline

AU - Nielsen, Rebecca

AU - Allen, Jody

AU - Eickhoff, Barbara

AU - Garrity, James

AU - Ladsten, Jacqueline

AU - Lebarron, Kathleen

AU - Link, Thomas P.

AU - Rostvold, Jay

AU - Weber, Karen

AU - Felton, Warren

AU - Boney, Tracy

AU - Gabriel, Danielle

AU - David, Daniel

AU - Fendelander, Lahn

AU - Geller, Daniel

AU - Jordan, Timothy

AU - Kim, Christian

AU - Munger, Craig

AU - Romandy, Anne

AU - Sanborn, George

AU - Schwartz, Bradley

AU - Sheusi, Carl

AU - Smith, Constance

AU - Talley, Kathy

AU - Thimmappa, Sandya

AU - Eggenberger, Eric

AU - Bickert, Suzanne

AU - Granadier, Robert

AU - Holliday, Sandra

AU - Moore, Thomas

AU - Varadarajan, Jaya

AU - Friedman, Deborah

AU - Jones, Patricia

AU - Amin, Haris

AU - Bersani, Thomas

AU - Briglin, Cynthia

AU - Fooks, James

AU - Graham, Michael

AU - James, Milton

AU - Michalec, Gary

AU - Nguyen, Hoang

AU - Horton, Jonathan

AU - Chang, Maeve

AU - Aber, Lou Anne

AU - Lindstrom, Erik

AU - Seiff, Stuart

AU - Guy, John

AU - Francis, Amye

AU - Hamed, Latif

AU - Lessner, Alan

AU - Mcdavid, Donna

AU - Shamis, Diana

AU - Goodwin, James

AU - Lindeman, Martin E.

AU - Putterman, Allen

AU - Bobak, Phyllis

AU - Baker, Robert

AU - Beck, Judy

AU - Cowen, David

AU - Epstein, Avrom

AU - Hanson, Michael

AU - Scoggins, Toni

AU - Rodavitch, Ann M.

AU - Gore, Brenda

AU - Blake, Andrea

AU - Heroux, Michele

AU - Kalsi, Rani

AU - Krauch, Charlene

AU - Millar, Mary Ann

AU - Wolin, Mitchell

AU - Brady, Rita Jean

AU - Hansen, Regina

AU - Briggs, Michael

AU - Chalam, Karkarla V.

AU - Danner, Barbara

AU - Simons, Beverly

AU - Stewart, Anne

AU - Digre, Kathleen

AU - Malmquist Webb, Lizbeth

AU - Blackburn, Terrell

AU - Baggaley, Susan

AU - Anderson, Richard

AU - Juarez, Charles

AU - Kaye, Bonnie

AU - Langer, Paul

AU - Mishra, Aditya

AU - Morris, Paula

AU - Osborn, Sandra

AU - Patel, Bhupendra

AU - Priskos, Tessie

AU - Staker, Sandra

AU - Warner, Judith

AU - Evans, Christine

AU - Aylor, Allison

AU - Childress, Carolyn

AU - Dickerson, Helen

AU - Fleming, Jane

AU - Harris, Nomine

AU - Hoyle, L. Sharon

AU - Murphy, Ellen

AU - Scott, James

AU - Summerville, Karen

AU - Terrell, Mariann

AU - Tyler, Lillian

AU - Linberg, John

AU - Breen, Lenore

AU - Michael, Michelle

AU - Campbell, Charlene

AU - Ellis, Brian

AU - Groves, Nancy

AU - Hobson, Robert

AU - Mcgregor, Gordon

AU - Shepherd, Laura

AU - Cohn, Edward

AU - Manatrey, Patricia

AU - Casey, Sara

AU - Johnson, John

AU - Kronner, Coletti

AU - Regan, Virginia

AU - Streasick, Patricia

AU - Kelman, Shalom

AU - Elman, Michael

AU - Rodavitch, Aim M.

AU - Scherer, Roberta

AU - Crawley, Barbara

AU - Hiner, Cheryl

AU - Howard, Lucy

AU - Langenberg, Patricia

AU - Lurye, Olga

AU - Riedel, Sara

AU - Sotos, Michelle

AU - Spioch, Laureen

AU - Starr, Joann

AU - Urban, Judy

AU - Waring, Mark

AU - Everett, Donald

AU - Dickersin, Kay

AU - Mccarter, Robert

AU - Seiff, Stuart R.

PY - 1995/2

Y1 - 1995/2

N2 - 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). —The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. —Twenty-five US clinical centers. —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. —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. —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. —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. —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.

AB - 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). —The Ischemic Optic Neuropathy Decompression Trial (IONDT) is a randomized, single-masked, multicenter trial. —Twenty-five US clinical centers. —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. —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. —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. —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. —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.

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U2 - 10.1001/jama.273.8.625

DO - 10.1001/jama.273.8.625

M3 - Article

C2 - 7844872

AN - SCOPUS:0028910230

VL - 273

SP - 625

EP - 632

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0098-7484

IS - 8

ER -

Optic Nerve Decompression Surgery for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Is Not Effective and May Be Harmful

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