Question 6: Discuss the management options for NAION.

Question 6: Discuss the management options for NAION.

Answer

There is as yet no medical or surgical intervention that has shown conclusive benefit in the treatment or prevention of NAION. The Ischaemic Optic Neuropathy Decompression Trial (IONDT) is a randomised, single-blind study, which investigated the effectiveness of optic nerve sheath fenestration (a surgical technique to create openings within the optic nerve sheath to reduce the hydrostatic pressure within the subarachnoid space of the optic nerve). This trial demonstrated no benefit of optic nerve sheath fenestration in acute NAION. Optic nerve sheath fenestration is therefore no longer offered as a treatment option.

Similarly, systemic corticosteroids and intravitreal injection of anti-VEGF antibodies have both been tested in clinical trials, but neither treatment significantly altered the course of NAION.

Referral to a physician for the management of cardiovascular risk factors is the mainstay of treatment. The goal of treatment is to reduce the chance of fellow eye involvement. Aspirin may be considered if there are no contraindications.

Answer ends