Neuro-ophthalmology

Optic neuritis treatment trial (ONTT), 1991 ⏩  ONTT2 ⏩
N= 457, 5y
Study question: 3 arms:PO/IV/PO placebo for non infectious optic neuritis. Study results: Visual recovery in all groups 4-6w. Final VA was PO=IV, but IV recovered faster. More recurrences in the PO than 2 other groups. 50% with ON will become MS in 15y. 25% risk with no MRI lesions. 1 lesion = 72%. At 2y less MS in IV. At 5y no difference. See this review as well.


The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. (IONT), 1999 ⏩
N=133
Following the results of the National Acute Spinal Cord Injury Study II and the Corticosteroid Randomization After Significant Head injury (CRASH) study.
Study Question: Multicenter non-randomized trial looking into steroids VS optic canal decompression VS observation for traumatic optic nerve injuries. Study results: No advantage in IV steroids or optic canal decompression. Conclusion: Treatment is an option to be considered.

Ischemic Optic Neuropathy Decompression Trial (IONDT), 2000 ⏩ and ⏩
N=258, 5y
Study question: NAION decompression of the ON vs no tx. Study results: No benefit for ONSD. No tx: 31% gained 3+ lines after 2y. 6.4% had recurrent episodes of vision loss in the same eye within 3m, mostly young pts. 2nd eye incidence in 5y-20% with risk factors of diabetes and VA of 6/60.



Non-arteritic anterior ischemic optic neuropathy: role of systemic corticosteroid therapy, 2008 ⏩
n=613,  mean 3.8y
Study question: Systemic steroid tx for NAION vs observation. Study results: At 6 months, eyes with initial VA 20/70 or worse and seen within 2 weeks of onset, there was VA improvement in 69.8%  vs 40.5% observed only. VF improved similarly. Both groups' VA and VF kept improving up to about 6m after the insult. Concerns about heterogeneity of patients raise doubts about true value of tx in NA-AION.


The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT): A Review of the Outcomes, 2017 ⏩
n=165. Primary outcome at 6m. Study duration 12m.
Study question: assess the efficacy of medical therapy for vision loss in IIH. Diet with Acetazolamide (1-4gr) or Placebo. Randomized double masked controlled Study. Results: Diet w\ Acetazolamide significant improvement in LP opening pressure, disc edema, QOL and visual fields of both eyes (+1.43 dB vs +0.71dB for diet only). Worsening of a VF was performance related in 83% - redo VF. VA insensitive measurement. OCT of edema is reliable. Headache and TVO improved by weight loss not tx. No significant side effects to tx up to 4gr/d.

Giant-Cell Arteritis Actemra Trial (GiACTA), 2017 ⏩
n=251, 1y (on going as of 2017)
Study question: Tocilizumab, an interleukin-6 receptor alpha inhibitor as steroid sparing for GCA. Phase 3 Double blind RCT. Results: 56% were steroid free VS 14% in placebo. q2~q1w but had one case of AION. Less adverse effects in tx group. Placebo group: No difference between 26w VS 52w steroid taper. $ by F. Hoffmann-La Roche



Traumatic optic neuropathy treatment trial: open label, phase 3, multicenter, semi-experimental trial (TONTT), 2018 ⏩
n=120, 3m
Study question: Erythropoietin (EPO) VS Steroids VS observation for Traumatic optic neuropathy. Study results:  All three groups showed a significant improvement of BCVA which was not significantly different between the groups (adjusted for pretreatment BCVA). Initial BCVA of NLP and late treatment (>3 days) were significant risk factors for worse outcome.




Abbreviation used on this page:
$ - Financial support (if relevant to results)
AION - Anterior ischemic optic neuropathy
BCVA - best corrected visual acuity
d - day
g - gram
GCA - Giant cell arteritis
IIH - Idiopathic Intracranial Hypertension
IV - Intravenous
LP - Lumbar puncture
MRI - Magnetic resonance imaging
MS - Multiple sclerosis
NLP - no light preception
ON - Optic neuritis
ONSD - optic nerve sheath decompression
PO - Per os
pts - patients
q2w - once every 2 weeks
QOL - Quality of life
RCT - Randomized controlled trial
TVO - Transient visual obscurations
Tx - Treatment
VA - Visual acuity
y-years
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