Visual fields at follow-up in the Ischemic Optic Neuropathy Decompression Trial: evaluation of change in pattern defect and severity over time.
OBJECTIVE
To evaluate change from baseline to 12 months follow-up in study and nonstudy (fellow) eye visual fields from the Ischemic Optic Neuropathy Decompression Trial (IONDT).


METHODS
Randomized controlled trial and observational study.


METHODS
The IONDT enrolled patients >or=50 years with acute nonarteritic ischemic optic neuropathy (NAION). Randomized patients (n = 258) had visual acuity <or=20/64; nonrandomized patients (n = 160) had visual acuity >20/64 or refused randomization.


METHODS
Optic nerve decompression surgery (n = 127) or careful follow-up (n = 131).


METHODS
We measured visual fields at baseline and at 6 and 12 months follow-up. Using a computerized system, we classified visual field defects by pattern, location, and severity. We examined changes over time by treatment group, age, baseline comorbidities, and change in visual acuity. In fellow (nonstudy) eyes, we assessed change by whether NAION was present at baseline and also incidence of NAION by whether a visual field defect was present at baseline.


RESULTS
We analyzed 245 study eye visual field pairs (179 and 66, randomized and nonrandomized, respectively) for change from baseline to 12 months. We observed significant changes in defect distribution within the central field (P = 0.02) for randomized eyes. Superior and inferior altitudinal defects were less severe at follow-up in both randomized and nonrandomized eyes. We observed an association between change in central field severity and change in visual acuity from baseline (P<0.001 at 6 months; P = 0.01 at 12 months; Kendall's tau-b), but no association between visual field change and treatment group, age, or baseline comorbidities. Superior and inferior visual field defects present at baseline in nonstudy eyes improved at follow-up. Fellow (nonstudy) eyes with normal fields did not have an increased risk of developing NAION compared with eyes with >or=1 defects.


CONCLUSIONS
Visual fields of NAION patients enrolled in the IONDT were relatively stable from baseline to follow-up. A visual field defect in the nonstudy eye at baseline was not associated with development of NAION during follow-up compared with eyes with normal fields.
Scherer
Roberta W
RW
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. rscherer@jhsph.edu
Feldon
Steven E
SE
Levin
Lori
L
Langenberg
Patricia
P
Katz
Joanne
J
Keyl
Penelope M
PM
Wilson
P David
PD
Kelman
Shalom E
SE
Dickersin
Kay
K
D000208:Acute Disease; D000368:Aged; D019299:Decompression, Surgical; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*