—Kwitko argues in favor of routine optic nerve sheath fenestration for treatment of progressive AION. He bases his argument on hypothetical considerations put forward by Sergott et al.1 There is general agreement that the pathogenesis of both the progressive and nonprogressive forms of AION relate to vascular compromise, mechanical compression, or both, at the level of the lamina cribrosa within the scleral canal.2 Thus, it is not clear that relieving "pressure" on the retrolaminar optic nerve would be any more beneficial than lowering the prelaminar pressure with ocular hypotensive agents. We must accept that the use of optic nerve sheath fenestration for progressive AION is supported only by a few clinical reports and not by any rigorously supported scientific hypotheses.Kwitko suggests that the visual fields of the two patients presented in our letter3 might have been even less constricted had surgery been performed. However,
Aiello AL, Sadun AA, Feldon S. Save the Optic Nerve-Reply. Arch Ophthalmol. 1993;111(3):300–301. doi:10.1001/archopht.1993.01090030018011
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