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Lenworth N Johnson, Deanna P Lyttle, Edward A Margolin, Richard W Madsen; Early Treatment with Levodopa Promotes Visual Improvement in Nonarteritic Anterior Ischemic Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the clinical effectiveness and potential neuroprotection of levodopa in improving visual acuity, visual field, and retinal nerve fiber layer (RNFL) thickness in eyes affected by NAION.
Retrospective cohort study involving 59 eyes of 59 participants with NAION evaluated within 15 days of NAION onset. Participants received 25mg carbidopa/100mg levodopa three times daily with meals for 12 weeks (Levodopa group) or untreated (Control group). Best corrected visual acuity converted to logMAR, mean deviation (MD) threshold sensitivity on automated perimetry, and mean RNFL thickness on optical coherence tomography (OCT) were assessed. The primary outcome was the categorization of eyes into improved visual acuity (by 0.3 logMAR difference), worsened visual acuity (by 0.3 logMAR difference), or no change in visual acuity. The proportions in each category were compared between the Levodopa and Control groups.
Among participants with 20/60 or worse initial visual acuity, Levodopa-treated participants had significant improvement (P< 0.0001) in the mean change from initial to final logMAR visual acuity of -0.74 ± 0.56 (95% CI, -0.98 to -0.50), while the mean change for the Control group at -0.37 ± 1.09 (95% confidence interval estimate,-1.00 to +0.26) was not significant (P= 0.23). A significant difference between groups was observed (P= 0.0086) such that 18/23 (78%) in the Levodopa group improved and none got worse, as compared with 6/14 (43%) in the Control group improving while 3 (21%) worsened. The change in visual field MD and RNFL thickness on OCT showed no significant difference at P= 0.23 and P= 0.75, respectively. No levodopa treated participant had any adverse event from the levodopa.
Treatment within 15 days of onset of NAION with levodopa improved central visual acuity by an average of 6 lines on Snellen acuity chart. Levodopa may promote neuroprotection of the maculopapular retinal ganglion cell fibers in NAION.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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