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August 1990

Does Optic Nerve Sheath Decompression Help Progressive Ischemic Optic Neuropathy?-Reply

Author Affiliations

Philadelphia, Pa

Arch Ophthalmol. 1990;108(8):1066. doi:10.1001/archopht.1990.01070100021009

In Reply.  —We appreciate Dr Wilson's comments regarding our article on optic nerve sheath decompression for progressive nonarteritic ischemic optic neuropathy (NAION). Our relatively large number of patients with progressive NAION reflects the clinical activity of the Wills Eye Hospital Neuro-Ophthalmology Service, Philadelphia, Pa, where we see over 4000 patients a year. The incidence of progressive visual loss in our population correlates well with the incidence reported by Boghen and Glaser.1 We agree with Dr Wilson that conclusive evidence is lacking to support a completely ischemic pathogenesis for NAION and believe that the alternative hypothesis proposed by Borchert and Lessell2 may have merit.However, we doubt that an inflammatory etiology for NAION has been overlooked, because the most complete histopathologic study of this entity did not demonstrate any vascular or neural inflammation.3 We believe that the focal ischemic neuropathies of diabetes mellitus satisfy the criteria for another

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