High-quality clinical evidence, derived from well-designed and implemented clinical trials, serves to advance clinical care and to allow physicians to provide the most effective treatments to their patients. The field of ophthalmology, including the subspecialty of neuro-ophthalmology, abounds with such high-quality clinical trials that provide Level 1 clinical evidence. This review article summarizes the research design, key findings, and clinical relevance of select monumental clinical studies in neuro-ophthalmology with the primary goal of providing the readers with the rationale for current standard of care of various neuro-ophthalmic diseases. This includes the Optic Neuritis Treatment Trial, Ischemic Optic Neuropathy Decompression Trial, Idiopathic Intracranial Hypertension Treatment Trial, Rescue of Hereditary Optic Disease Outpatient Study, and Controlled High-Risk Avonex® Multiple Sclerosis Study
Optic Neuritis ; Optic Neuropathy, Ischemic ; Intracranial Hypertension

No abstract available.
Magnetic Resonance Imaging* ; Optic Neuropathy, Ischemic*

No abstract available.
Giant Cell Arteritis* ; Giant Cells* ; Korea* ; Optic Neuropathy, Ischemic*

No abstract available.
Giant Cell Arteritis* ; Giant Cells* ; Headache* ; Optic Neuropathy, Ischemic*

PURPOSE: Optic disc edema in anterior ischemic optic neuropathy (AION) and optic neuritis (ON) have overlapping features. To determine whether characteristics of optic nerve swelling help to differentiate ON from AION. METHODS: A medical records were reviewed retrospectively for the patients who had been diagnosed as AION or ON in which photographs for acute phase were available. Color of optic disc, distribution of edema, presence of hemorrhage and caliber of artery and vein was analyzed in each fundus photograph. RESULTS: AION was diagnosed clinically in 67% of the cases with altitudinal edema, in 77% of the cases with disc hemorrhage, in 87.5% of the cases with pallid optic disc and in 77% of the cases with vascular abnormality. A pale optic disc with hemorrhage, regardless of the type of edema, always represented AION (100%). Normal-colored optic disc without hemorrhage always also represented optic neuritis (100%). CONCLUSIONS: Analysis of disc characteristics may enhance diagnostic accuracy and help to differentiate AION from ON.
Arteries ; Edema ; Hemorrhage ; Humans ; Medical Records ; Optic Nerve ; Optic Neuritis* ; Optic Neuropathy, Ischemic* ; Retrospective Studies ; Veins

Recently, endoscopic sinus surgery (ESS) has been acknowledged as a standard surgical procedure for the treatment of chronic rhinosinusitis. Orbital complications of varying degrees that may occur during ESS have been widely reported. Blindness, one of the major complications that can occur during or immediately after ESS, is mainly attributed to orbital hematoma or direct injury to the optic nerve. In contrast to such direct mechanical trauma caused during ESS, we report a case of acute loss of vision that followed ESS without a definite cause. A postulated mechanism for idiopathic optic neuropathy is that it is ischema resulted from vasospasm in the branches of ophthalmic artery due to topical use of vasoconstrictive agents. Otorhinolaryngologists should be aware that this condition may occur following an uncomplicated ESS procedure. When loss of sight is diagnosed postoperatively, patients should be given prompt ophthalmological consultation and possible causes should be considered.
Blindness ; Hematoma ; Humans ; Ophthalmic Artery ; Optic Nerve ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Orbit ; Vision, Ocular

PURPOSE: To improve the treatment efficiency of optic nerve diseases by delivering therapeutic materials to the optic nerve directly. METHODS: We tried to optimize liposomal composition to deliver a payload to the optic nerve efficiently when it is injected intravitreally. After loading dexamethasone into this liposome, we tested the therapeutic effect of liposomes in this treatment using a murine model of ischemic optic neuropathy. RESULTS: Our optimized liposome can deliver its payload to the optic nerve more efficiently than other tested compositions. Moreover, dexamethasone-loaded liposomes had a significant therapeutic effect in a murine model of ischemic optic neuropathy. CONCLUSIONS: Here, we demonstrate the optimal composition of liposomes that could efficiently deliver intravitreally injected exogenous compounds to the optic nerve. We expect that the intravitreal injection of liposomes with the suggested composition would improve the delivery efficacy of therapeutic compounds to the optic nerve.
Dexamethasone ; Intravitreal Injections* ; Liposomes* ; Optic Nerve Diseases ; Optic Nerve* ; Optic Neuropathy, Ischemic

The development of optical coherence tomography (OCT) has changed the clinical management of ophthalmic diseases by furthering the understanding of pathogenesis, as well as improving the monitoring of their progression and assisting in quantifying the response to treatment modalities in ophthalmic diseases. Initially, the two-dimensional configuration of the optic nerve head (ONH) and the thickness of the retinal nerve fiber layer (RNFL) were the main OCT structural parameters used in clinical management of optic nerve diseases. Now, with higher resolution power and faster acquisition times, the details of ONH and the retina including the macular area can be measured using spectral domain OCT (SD-OCT) with high reproducibility and increased diagnostic ability. OCT can provide structural information to improve the understanding and management of optic nerve diseases. In this review, we will briefly summarize the clinical applications of SD-OCT in glaucoma and nonarteritic anterior ischemic optic neuropathy, which are two representative optic nerve diseases.
Glaucoma ; Nerve Fibers ; Optic Disk ; Optic Nerve Diseases ; Optic Neuropathy, Ischemic ; Retina ; Retinaldehyde ; Tomography, Optical Coherence

The authors clinically analyzed 240 patients of optic nerve diseases who visited the Department of Ophthalmology of Kyung Hee University hospital during four and a half years from July 1985 to February 1990. The most common optic nerve disease was optic nerve atrophy(59.2%), followed by optic neuritis, anterior ischemic optic neuropathy, papilledema, compressive optic neuropathy, retrobulbar optic neuritis, toxic neuropathy, and anomaly of optic nerve. According to sex, there was no significant difference between female and male. In comparison with age groups, the largest group was in the age group of 21-30 years. In cases of optic nerve atrophy, the most common cause was trauma(29.1%), most common age group was 21-30 years. In cases of optic neuritis, the most common cause was idiopathic(61.7%), most common age group was 31-40 years. Visual improvement was seen in 85.3%. In cases of anterior ischemic optic neuropathy, the most common cause was idiopathic(35.0%), most common age group was 41-50 years. Visual improvement was seen in 15%. In cases of papilledema, the most common cause was brain tumor (88.2%), most common age group was 41-50 years.
Atrophy ; Brain Neoplasms ; Female ; Humans ; Male ; Ophthalmology ; Optic Nerve Diseases* ; Optic Nerve* ; Optic Neuritis ; Optic Neuropathy, Ischemic ; Papilledema

Anterior ischemic optic neuropathy is due to acute ischemia of the anterior part of the optic nerve, whose main source of blood supply is from the posterior ciliary circulation, either by direct branches or through the peripapillary choroid, with minor and differing contributions from other sources. The clinical features are charaterized by sudden visual impairment, optic nerve related visual field defect and optic disc edema. For pathogenetic as well as therapeutic reasons, these patient can be subdivided into two major subgroups: a nonarteritic group, an arteritic group. The authors experienced a case of AION, which occurred in a young male, probably arteritic. So, the literature of the AION was briefly reviewed and the purpose of this review is to increase awareness of this not uncommon condition.
Choroid ; Edema ; Humans ; Ischemia ; Male ; Optic Nerve ; Optic Neuropathy, Ischemic ; Vision Disorders ; Visual Fields