Levodopa may improve vision loss in recent-onset, nonarteritic anterior ischemic optic neuropathy

Objectives To study the effect of levodopa in improving visual function in patients treated within 45 days of onset of nonarteritic anterior ischemic optic neuropathy (NAION), Designs Nonrandomized, retrospective, comparative trial. Participants: The study involved 37 patients with NAION of less than 45 day s duration. Methods: Eighteen patients who had been treated with levodopa were assigned to the case group, and 19 untreated patients were assigned to the control group. Snellen visual acuity converted to logMAR and mean deviation on Hump hrey automated perimetry (Program 24-2, Humphrey Instruments, San Leardro, CA) were evaluated at the initial and 6-month visits. Interventions The 18 patients in the case group were administered a capsule of 100 mg levodopa/25 mg carbidopa (Sinemet 25-100) three times daily for 3 weeks. Main Outcome Measures: The primary outcome measures were changes in visual acuity and visual field at 6 months from baseline. Improvement in visual ac uity was defined as a difference of -0.3 logMAR or less between the B-month and initial visual acuities, whereas worsened visual acuity was a differen ce of +0.3 logMAR or more. Each 0.3 LogMar represented a doubling of the vi sual angle, i.e., a change by three lines on the eye chart, Improvement in visual field was defined as a difference in mean deviation of +3.0 dB or mo re between the B-month and initial visual field tests, whereas worsened vis ual field was a difference in mean deviation of -3.0 dB or less. Results: T he proportions of patients with worsened, unchanged, and improved visual ac uity at 6 months were compared for the levodopa and control groups. There w as a significant difference (P = 0.012) between the groups. Examination of the proportions showed that a higher proportion of patients who received le vodopa had improved visual acuity with a corresponding lower proportion hav ing worsened visual acuity as compared with the control patients. Ten of 13 patients (76.9%) in the levodopa group with 20/40 visual acuity or worse a t baseline had improved visual acuity at 6 months, and none of the 18 patie nts had worsened visual acuity. In contrast, 3 of 10 control patients (30%) with 20/40 visual acuity or worse at baseline had improved visual acuity a t 6 months, and 3 of 19 control patients (16.3%) had worsened visual acuity . The proportions of patients with worsened, unchanged, and improved visual fields at 6 months were compared for the levodopa and control groups. Ther e was no significant difference between the groups (P = 0.25), Conclusions: Patients treated with levodopa within 45 days of onset of NAIO N were more likely to experience improvement and less likely to have worsen ed visual acuity than untreated patients. Levodopa appears to be beneficial in the treatment of recent-onset NAION. (C) 2000 by the American Academy o f Ophthalmology.