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    Neuroprotective drug may be possible NAION therapy

    International trial under way with new siRNA; interim analysis may be available mid-year

    Reviewed by Neil R. Miller, MD

    Non-arteritic ischemic optic neuropathy (NAION) can be challenging to treat. Ophthalmologists have used several therapies with patients—ranging from steroids to ranibizumab and bevacizumab—all with mixed results reported in the literature, said Neil R. Miller, MD.

    Yet, effective treatments for NAION are crucial because the condition is the most common reason for sudden optic nerve-related visual loss in the older population.

    “It affects 10,000 people in the United States every year, and it’s second only to glaucoma in optic nerve damage in older people,” said Dr. Miller, Frank B. Walsh professor of neuro-ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

    Effective treatments for NAION are also increasingly important because of certain health conditions growing in the United States and worldwide, including obesity, diabetes, and hypertension.

    A. A typical visual field of non-arteritic ischemic optic neuropathy (NAION). B/C. Disc photos of acute NAION. (Images courtesy of Neil R. Miller, MD)
    “Patients with NAION tend to be those with underlying vascular disorders,” he said.

    Additionally, even though 40% of patients with NAION improve without treatment, 60% do not. About 20% of patients will have their second eye affected as well.

    “We have no consistent treatment and once someone loses vision in one eye, let alone both eyes, doing daily activities is affected,” Dr. Miller said.

    Now, a multicenter phase II/III trial is under way to try a new neuroprotective drug as a potential treatment.

    Trial cohorts

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