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In this retina case conference, Drs. Kevin Harvey and Kimberly Jun present a 48-year-old woman who developed sudden inferior visual field loss in the right eye. Fundus examination revealed segmental optic nerve head edema with flame hemorrhages, and visual field testing confirmed an inferior altitudinal defect—classic findings for non-arteritic anterior ischemic optic neuropathy (NAION). The case underscores key clinical features of NAION, including the “disc at risk” appearance, absence of pain, and preservation of central vision. A unique aspect of this case is the patient’s use of tirzepatide (Mounjaro), a GLP-1 receptor agonist, prompting a discussion of recent studies exploring a potential association between GLP-1 use and NAION. The presenters review two large retrospective studies—one suggesting an increased risk of NAION with semaglutide, while another found no statistically significant link. This presentation offers valuable insights into the diagnosis and management of NAION and raises timely questions about emerging medication-related risk factors. An important case for retina specialists, neuro-ophthalmologists, and general ophthalmologists.

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