Ischemic optic neuropathy is the most common cause of sudden vision loss in patients over 50 years of age. Often, due to a combination of factors including the natural configuration of the patient’s optic nerve, as well as changes in blood supply to the optic nerve, the nerve suffers a “mini stroke.” It may occur in patients with risk factors including obesity, tobacco use, or hypertension. Patients often notice a sudden change in vision which may be mild or severe. Furthermore, patients may also appreciate the loss of the top half or bottom half of their side vision. In some cases, there can be an improvement of vision over time. The best course of “treatment” is to optimize the risk factors with blood pressure management, weight loss, and use of aspirin, to help improve the blood supply throughout the body.