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Most of the patients who developed NAION had underlying anatomic or vascular risk factors for the development of NAION, including, but not limited to, low cup to disc ratio "crowded disc"age older than 50 years, diabetes, hypertension, coronary symptoms and treatment disease, Erectile Dysfunction causes, and smoking. Patients with known hereditary degenerative retinal disorders, normal erection retinitis pigmentosa, symptoms, were not included in clinical trials; tadalafil use is not recommended in these patients. Use tadalafil cautiously in patients with gastroesophageal reflux disease GERD or hiatal hernia associated with reflux esophagitis.

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