Clinical trials for inherited optic neuropathies

Abstract

SummaryThe best scientific evidence for use of a clinical intervention is based upon data obtained from Phase III clinical trials. The robustness of a clinical trial is dependent on the quality of the metrics collected which in turn is dependent on the design of the study. Clinical trials involving inherited optic neuropathies such as Leber's Hereditary Optic Neuropathy (LHON) encounter some unique challenges which can be divided into two broad groups: patient‐centric factors and test‐centric factors. Patient‐centric factors include the heterogeneous phenotypic presentations in LHON with variable rates of spontaneous recovery and time to nadir and plateau. Test‐centric factors include the subjective nature of most visual metrics; intertest and intratest variability, which is compounded by patient adaptation to visual loss. Collectively these issues must be addressed when designing a clinical trial, especially in rare diseases where patient recruitment can be a challenge