PDE5 inhibitors and permanent visual loss

Abstract

Editor's note: Nonarteritic anterior ischemic optic neuropathy (NAION), a form of optic nerve stroke, has received attention as the result of a possible rare association with PDE5 inhibitors (PDE5i). The possible mechanism of the PDE5i interaction with NAION is unclear, and the sporadic case reports do not seem to shed light on this topic. There is little guidance on this subject for the patient and clinician alike. Nonetheless, clinicians are being deluged with queries, without definitive answers. At this juncture, an ophthalmologic evaluation is discretionary, and appears to be based on either patient desire, patient risk factor profile, or clinician instinct. The scientific literature is scant as well. Several case reports exist to date, without clear vision for the future study of this disease. Robert Tomsak, a noted neuro-ophthalmologist, discusses NAION here.