As recently as 1989, ophthalmologists had no treatment for nonarteritic anterior ischemic optic neuropathy (NAION). Primarily affecting the elderly, NAION can devastate vision, since it affects both eyes in 40% of afflicted patients and leads to visual acuity of 20/200 or worse in 45% of affected eyes.1 Although most neuro-ophthalmologists believe that the likelihood of spontaneous improvement is low, published reports show a wide range of spontaneous visual improvement in cases of NAION, varying between 5% and 33%.1,2 Unfortunately, most published reports describing the natural history of NAION were based on medical records reviews and did not use standardized methods of data measurement or collection. In addition, most reports are based on small numbers of patients who are followed up for varying lengths of time. Until prospectively collected data on untreated patients become available, information regarding the natural history of NAION must be interpreted cautiously.
Until recently, the
Kelman SE. The Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol. 1993;111(12):1616-1618. doi:10.1001/archopht.1993.01090120038017