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Monitoring recommendations for high-risk patients If you have three or more NAION risk factors and you and your provider decide to proceed with Mounjaro or compounded tirzepatide, the following monitoring approach is reasonable: Before starting treatment: Dilated fundoscopic exam by an ophthalmologist to assess optic disc size and appearance Blood pressure measurement, ideally including nocturnal ambulatory monitoring if available Sleep apnea screening (STOP-BANG questionnaire or home sleep study if high suspicion) Baseline visual field testing if optic disc appears crowded During treatment: Repeat dilated exam at 6 months and 12 months, then annually Blood pressure monitoring, especially during dose escalations Patient education on NAION symptoms with explicit instructions to seek same-day ophthalmology care for sudden vision loss Avoidance of other medications that may increase NAION risk (e.g., phosphodiesterase-5 inhibitors, though the data is mixed) If vision changes occur: Same-day ophthalmology evaluation for sudden vision loss Routine ophthalmology evaluation within 1 to 2 weeks for gradual or transient vision changes Do not assume vision changes are "just a side effect" without ruling out NAION or retinopathy progression This level of monitoring is not standard for all GLP-1 patients