Which class of drugs has been linked to non-arteritic anterior ischemic optic neuropathy (NAION)?

• A. PDE-5 inhibitors
• B. Beta blockers
• C. Proton pump inhibitors
• D. SSRIs

Answer: (A)

PDE-5 inhibitors have been linked to non-arteritic anterior ischemic optic neuropathy because they can cause systemic vasodilation and a transient drop in blood pressure, which may reduce ocular perfusion pressure at the optic nerve head in individuals with vascular risk or a structurally vulnerable optic disc. In patients with a predisposed “disc at risk,” this transient ischemia can precipitate NAION. While the exact mechanism isn’t fully proven, case reports and series have repeatedly noted associations between PDE-5 inhibitors and NAION, making this class the most consistently implicated among the options. The other drug classes listed do not have a well-established link to NAION in the literature.