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Diegel is correct that the IONDT is sponsored by the National Eye Institute, which is within the National Institutes of Health. Patients in the IONDT are randomly assigned to either careful follow-up or optic nerve sheath decompression surgery, which is an established procedure that has been used as a treatment for nonarteritic ischemic optic neuropathy since 1989. Because both treatment assignments are within the realm of care normally provided by neuro-ophthalmologists to patients with nonarteritic ischemic optic neuropathy, it is reasonable to expect patients' insurance companies to pay patient care costs. In fact, participating institutions received reimbursement for both careful follow-up and surgery before joining the IONDT. The National Eye Institute has made funds available to the participating institutions for care of indigent patients.The funding provided by the National Eye Institute permits the IONDT clinical centers to collect and record the detailed information required by the
Kelman SE. The Ischemic Optic Neuropathy Decompression Trial-Reply. Arch Ophthalmol. 1994;112(10):1275–1276. doi:10.1001/archopht.1994.01090220025005
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