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The purpose of this study was to assess if 4-aminopyridine (4-AP), a potassium-channel blocker that improves nerve conduction along demyelinated axons, improves visual acuity or other measures of visual function in multiple sclerosis (MS) patients with optic neuropathy. (An extended-release formulation is FDA-approved to improve walking in MS.) Enrolled patients had retinal nerve fiber layer thickness (RNFL) of ≤80 µm in one or both eyes or had a >10-µm difference between their eyes. They underwent baseline high-contrast and low-contrast (2.5% and 1.25%) visual acuity testing, optical coherence tomography, and visual evoked potentials (measuring P100 latency). Twenty two patients were randomized to compounded 4-AP (titrated over 5 weeks to …