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Levodopa as a possible treatment of visual loss in nonarteritic anterior ischemic optic neuropathy

  • Neurophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

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.

Method

Retrospective cohort study involving 59 eyes of 59 participants with NAION who were evaluated within 15 days of NAION onset. Participants received 25 mg carbidopa/100 mg levodopa three times daily with meals for 12 weeks (levodopa group) or were 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.

Results

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 19/23 (83 %) in the levodopa group improved and none got worse, as compared with 6/14 (43 %) in the control group improving while four (29 %) 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.

Conclusions

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.

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Author information

Authors and Affiliations

  1. Neuro-Ophthalmology Unit, Mason Eye Institute, University of Missouri–Columbia, Columbia, MO, USA

    Deanna P. Lyttle & Lenworth N. Johnson

  2. Neuro-Ophthalmology Unit, Rhode Island Hospital, Department of Ophthalmology, Alpert Medical School of Brown University, 1 Hoppin Street, Suite 200, Providence, RI, 02903, USA

    Lenworth N. Johnson

  3. Neuro-Ophthalmology Unit, Department of Ophthalmology, Mount Sinai Hospital, Toronto, ON, Canada

    Edward A. Margolin

  4. Neuro-Ophthalmology Unit, Biostatistics Unit, University of Missouri–Columbia, Columbia, MO, USA

    Richard W. Madsen

Authors
  1. Deanna P. Lyttle
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  2. Lenworth N. Johnson
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  3. Edward A. Margolin
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  4. Richard W. Madsen
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Corresponding author

Correspondence to Lenworth N. Johnson.

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Funding

Research to Prevent Blindness, Inc. (New York, New York) provided financial support in part, in the form of an unrestricted grant to the Department of Ophthalmology at the University of Missouri–Columbia. The sponsor had no role in the design or conduct of this research.

Conflict of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards. For this type of study, formal consent was not required.

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Lyttle, D.P., Johnson, L.N., Margolin, E.A. et al. Levodopa as a possible treatment of visual loss in nonarteritic anterior ischemic optic neuropathy. Graefes Arch Clin Exp Ophthalmol 254, 757–764 (2016). https://doi.org/10.1007/s00417-015-3191-z

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  • DOI: https://doi.org/10.1007/s00417-015-3191-z

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