AIM: To explore the correlation between remnant cholesterol (RC) and anterior ischemic optic neuropathy (AION). METHODS: Eighty cases of AION patients hospitalized in the Department of Ophthalmology of Linyi People's Hospital from January 2020 to December 2023 were selected as the observation group, and eighty cases of those who had completed health checkups in Linyi People's Hospital during the same period (without ischemic optic neuropathy and other fundus vasculopathies) were selected as the control group. The general data and biochemical indexes of the two groups were compared to evaluate the correlation between RC and anterior ischemic optic neuropathy. RESULTS: Compared with the control group, the levels of remnant cholesterol (RC), fasting blood glucose (FBG), total triglycerides (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) in patients with AION were significantly higher than those in the control group, and the difference was statistically significant (P<0.05). Pearson correlation analysis showed that RC was positively correlated with TG, TC, and LDL-C (P <0.05). Logistic regression analysis showed that RC and FBG were risk factors for the development of AION. The analysis of receiver operating characteristic (ROC) curves showed that the level of RC had a better predictive value for the development of AION compared with FBG. CONCLUSION:RC is associated with the development of anterior ischemic optic neuropathy and is a risk factor for the development of anterior ischemic optic neuropathy. Clinical standardization of the management of people with high RC values can reduce the risk of the development of anterior ischemic optic neuropathy, which is of clinical significance.