The purpose of this study is to evaluate the feasibility of rapid evaluation and administration of ophthalmic Timolol maleate in the treatment of non-arteritic anterior ischemic optic neuropathy. Secondary goals are to evaluate if such treatment reduces the progression or improves recovery of patients who are randomly assigned to treatment versus standard of care.
Non-arteritic anterior ischemic optic neuropathy (NAION) currently has no widely accepted acute treatment to improve recovery or prevent progression in the first month. It causes monocular vision loss with potential second eye involvement in 15% at 5 years. This leads to significant disability. It is the most common acute optic neuropathy in patients over 55 years of age. The final mechanism of injury is believed to be ischemic. Increasing perfusion of the optic nerve may reduce damage and prevent progression. Reduction in intraocular pressure has been shown to increase optic disc perfusion in animal models. Timolol maleate is a widely used medication for Glaucoma that reduces intraocular pressure. Treatment with Timolol maleate may improve optic disc perfusion in NAION and reduce ischemic damage from this condition. This study aims to enroll and treat patients with Timolol maleate 0.5% within 48 hours of symptom onset to assess feasibility of the study design and potential benefit of rapid intraocular pressure reduction.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Timolol 0.5% 1 drop twice daily to the effected eye for 4 weeks.
Jim Pattison Outpatient Care and Surgery Centre, 3C Neurology
Surrey, British Columbia, Canada
Recruitment Rate of patients during the one year study to assess feasibility of a larger study
This is to define the feasabilty of the study design for a larger study.
Time frame: 12 months
Number of patients with adverse events
Time frame: 12 months
Change in visual acuity at enrollment and three month follow up using a logMAR scale.
This will evaluate the change in visual acuity as a measure of visual function.
Time frame: Enrolment, Within 48 hours of enrollment , 1 month, 3 months.
Change in the mean deviation of actual versus predicted sensitivity of the visual field.
Using a a Haag-Streit Octopus 900 with white on white TOP 30-2 visual field program, the mean deviation will be compared at various time points to assess for improving visual function as it relates to the field of vision.
Time frame: 48 hours after enrollment, 1 month, 3 months
Change in Colour vision as measured by HRR colour plates.
The total number of colour plates seen will be counted and compared to baseline as a measure of visual recovery as it effects colour vision.
Time frame: Within 48 hours of enrollment, 1 month, 3 months
Change in contrast sensitivity will be measured using the Pelli-Robson contrast sensitivity chart.
The Pelli-Robson contrast sensitivity chart is another method to assess visual function. The change in total number of plates seen will be compared at the various time points.
Time frame: 48 hours from enrollment, 1 month, 3 months.
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