- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00000127
Ischemic Optic Neuropathy Decompression Trial (IONDT)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Non-arteritic ischemic optic neuropathy (NAION), the most common cause of acute optic nerve disease in older persons, causes permanent and severe visual loss. Visual function can be impaired through decreased central visual acuity or peripheral field loss, or both. NAION strikes both eyes in up to 40 percent of affected patients. The incidence of NAION has been estimated at 2.3 per 100,000 persons over the age of 50 years and 0.54 per 100,000 for all ages. Estimates of the number of new cases seen each year in the United States range from a low of approximately 1,500 to a high of 6,000.
NAION has been hypothesized to be caused by vascular insufficiency leading to optic nerve head ischemia. There is general agreement that NAION results from transient non-perfusion of nutrient vessels. The wide range of visual field defects and visual loss with NAION can be explained by the extent and number of the blood vessels involved.
Anatomical factors appear to contribute to the vascular event initiating NAION. Clinically, the number of discs congenitally lacking a physiological cup in eyes with NAION is higher than expected. Presumably, in eyes with NAION, these discs have small scleral openings that crowd the nerve fibers as they pass through the restricted space in the optic disc and lamina cribrosa, thereby predisposing to an ischemic spiral.
One current theory holds that NAION begins as a minor ischemic event that later progresses to a major infarction due to congenitally anomalous optic nerves. The inciting ischemic event leads to local anterior nerve edema, and this causes further ischemia.
Optic nerve sheath decompression surgery was reported in 1989 to be of benefit to patients with NAION. The presumed mechanism of action in optic nerve decompression surgery revolved around restoration of impaired blood flow to the optic nerve through reduction of the pressure around the nerve.
The Ischemic Optic Neuropathy Decompression Trial (IONDT) was a randomized clinical trial designed to compare the improvements in visual acuity at 6 months in patients assigned to receive surgery with optic nerve sheath decompression with those assigned to careful followup. A cohort of patients, with a baseline visual acuity of better than 20/64 are also being followed to better understand the natural history of the disease, including second eye involvement.
Enrollment began in October 1992. Randomization was stratified by clinic, and patients had an equal probability of assignment to surgery or careful followup. All patients are being followed for a minimum of 2 years.
The primary outcome is a change of three lines or more in visual acuity at the 6-month followup visit compared with visual acuity measured at the randomization visit.
Secondary outcomes include a change in visual acuity beyond 6 months, change in peripheral visual function as measured by automated Humphrey perimetry, local and systemic side effects from treatment, change in quality of life, and other associated morbidity and mortality.
Study Type
Phase
- Phase 3
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful. The Ischemic Optic Neuropathy Decompression Trial Research Group. JAMA. 1995 Feb 22;273(8):625-32.
- The ischemic optic neuropathy decompression trial (IONDT): design and methods. Control Clin Trials. 1998 Jun;19(3):276-96. doi: 10.1016/s0197-2456(98)00003-8.
- Characteristics of patients with nonarteritic anterior ischemic optic neuropathy eligible for the Ischemic Optic Neuropathy Decompression Trial. Arch Ophthalmol. 1996 Nov;114(11):1366-74. doi: 10.1001/archopht.1996.01100140566007.
- Scherer RW; Crawley B; Abstracts for the Ischemic Optic Neuropathy Study Group; Responses to ethical and other questions on a knowledge assessment form for a multicenter trial. [Abstract]., Controlled Clinical Trials 1993;14:442S
- Crawley B; Scherer RW; Ischemic Optic Neuropathy Decompression Trial (IONDT): Participation in the IONDT. Race, gender and age. [Abstract]., Controlled Clinical Trials 1994;15:102S
- Crawley B; Waring MT; Scherer RW; Coordinating Center for the Ischemic Optic Neuropathy Decompression Trial (IONDT): IONDT tracking system: Where is form 2034 for patient ICMORE and who is responsible? [Abstract]., Controlled Clinical Trials 1994;15:93S
- Kaufman D; Ischemic Optic Neuropathy Decompression Trial Study Group; Optic nerve decompression surgery for nonarteritic ischemic optic neuropathy (NAION is not effective and could be harmful: Results of the Ischemic Optic Neuropathy Decompression Trial (IONDT). [Abstract]., Invest Ophthalmol Vis Sci 1995;36:S196
Study record dates
Study Major Dates
Study Start
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- NEI-26
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Ischemic Optic Neuropathy
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Shahid Beheshti University of Medical SciencesUnknownAcute Nonarteritic Anterior Ischemic Optic NeuropathyIran, Islamic Republic of
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Instituto Universitario de Oftalmobiología Aplicada...University of ValladolidActive, not recruitingNon Arteritic Ischemic Optic NeuropathySpain
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Fraser HealthWithdrawnIschemic Optic Neuropathy | Optic Neuropathy, Ischemic | Anterior Ischemic Optic Neuropathy | Optic Neuropathy, Anterior IschemicCanada
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Shahid Beheshti University of Medical SciencesUnknownNAION( Non-arteritic Anterior Ischemic Optic Neuropathy)Iran, Islamic Republic of
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Emory UniversityCompletedNon-Arteritic Anterior Ischemic Optic NeuropathyUnited States
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Shahid Beheshti University of Medical SciencesUnknownNon-Arteritic Anterior Ischemic Optic Neuropathy (NAION)Iran, Islamic Republic of
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Jeffrey L GoldbergCompletedIschemic Optic Neuropathy/Optic Nerve StrokeUnited States
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Rigshospitalet, DenmarkUniversity of Colorado, Denver; King's College Hospital NHS Trust; Odense University... and other collaboratorsRecruitingNon-arteritic Ischemic Optic Neuropathy | Optic Disk DrusenDenmark, United Kingdom, United States, Australia, Canada, France, Iran, Islamic Republic of, Israel, New Zealand
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Neuro-Ophthalmologic Associates, PCAcorda TherapeuticsCompletedNon Arteritic Ischemic Optic NeuropathyUnited States
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Omar SaidCompletedNon-arteritic Ischemic Optic NeuropathyEgypt
Clinical Trials on Optic Nerve Sheath Decompression Surgery
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Leiden University Medical CenterNot yet recruitingHypertension | Papilledema | Hypertensive Emergency
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Kocaeli UniversityRecruitingIntracranial Pressure Increase | Optic Nerve Sheath DiameterTurkey
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Vanderbilt UniversityUnited States Department of DefenseCompleted
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Kantonsspital AarauUnknownGlaucoma Open-AngleSwitzerland
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Konya City HospitalCompletedExtracorporeal Life SupportTurkey
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Kanuni Sultan Suleyman Training and Research HospitalCompleted
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IRCCS Istituto delle Scienze Neurologiche di BolognaNot yet recruitingIntra Cerebral Hemorrhage | Stroke, Ischemic | Subarachnoid Hemorrhage, Aneurysmal | Trauma, Brain | Hypertension IntracranialItaly
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Ondokuz Mayıs UniversityCompletedFluid Challenge | Increased Intracranial PressureTurkey
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Zagazig UniversityCompleted
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Yonsei UniversityWithdrawn