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The aspect raised by the letter to the editor from Brown is indeed one that merits mention. The authors agree with the opinion expressed, that outcome measures pertaining to central vision include many more than visual acuity alone. However, because the presenting visual acuity in cases of nonarteritic anterior ischemic neuropathy is often very low, it precludes the possibility of performing a reliable visual field or contrast sensitivity examination. In a previous publication, we have described the changes in contrast sensitivity and visual fields in cases of nonarteritic anterior ischemic neuropathy over a 3-month period.1Saxena R. Singh D. Saha R. et al.Clinical profile of non-arteritic anterior ischaemic optic neuropathy in India and factors predictive of visual outcome.EC Neurol. 2016; 3: 354-361Google Scholar However, the experience from that study showed there is limited reliability of the Goldmann kinetic perimetry and definition of improvement or change in visual fields is relatively vague. Hence, these measurements were not included as a part of this clinical trial.2Saxena R. Singh D. Sharma M. et al.Steroids versus no steroids in nonarteritic anterior ischemic optic neuropathy: a randomized controlled trial.Ophthalmology. 2018; 125: 1623-1627Abstract Full Text Full Text PDF Scopus (23) Google Scholar We have performed a subanalysis, with regard to the point about the number needed to treat to achieve a positive outcome (a 2-line improvement in the logarithm of the minimum angle of resolution of visual acuity). In the group of patients who received steroids, 89.5% showed ≥2 lines of improvement in visual acuity compared with 68.4% in the group on placebo. This finding implies that the number need to treat is 4.7 to achieve significant visual acuity improvement. As shown in our trial, although the final best-corrected visual acuity did not differ between the steroid-treated and placebo groups, a greater mean improvement in best-corrected visual acuity was observed in the steroid group.2Saxena R. Singh D. Sharma M. et al.Steroids versus no steroids in nonarteritic anterior ischemic optic neuropathy: a randomized controlled trial.Ophthalmology. 2018; 125: 1623-1627Abstract Full Text Full Text PDF Scopus (23) Google Scholar Whether it is adequate to consider treatment with oral steroids in nondiabetic patients may be decided by the treating physician in consultation with the patient. We agree that there is a need to continue to study the potential role of oral steroids for treatment of nonarteritic anterior ischemic neuropathy in nondiabetic patients with studies of a larger sample size with enrollment early in the course of the disease to more definitely ascertain their effects on visual outcomes. Re: Saxena et al.: Steroids versus no steroids in nonarteritic anterior ischemic optic neuropathy: a randomized controlled trial (Ophthalmology. 2018;125:1623–1627)OphthalmologyVol. 126Issue 6PreviewI read with interest the article by Saxena et al1 on oral prednisone treatment for nonarteritic anterior ischemic optic neuropathy in nondiabetic patients. I agree with the authors that the ophthalmology community has been frustrated and confused by the conflicting literature on the benefit of steroids for nonarteritic anterior ischemic optic neuropathy.2 Full-Text PDF