AIM: To evaluate the atherogenic indices and the relationship with visual acuity and bilateral sequential involvement in patients with non-arteritic ischemic optic neuropathy (NAION). METHODS: A total of 65 patients with NAION and 48 age-sex matched healthy individuals were included in this retrospective study. The demographic characteristics and laboratory findings of the patients and control subjects were obtained from the electronic medical records. The atherogenic indices were calculated using the lipid parameters. The association between visual acuity, bilateral sequential involvement, and atherogenic indices was investigated. RESULTS: The mean age was 63.8±12.5y in the NAION group and 64.7±10.1y in control group (P=0.707). Although there were no significant differences in terms of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) between two groups (P=0.089, 0.091), all the non-traditional serum lipid ratios were significantly higher in NAION group (P<0.05). In the NAION subgroup analysis, with visual acuity≤20/200 had higher TC/high-density lipoprotein cholesterol (HDL-c), LDL-c/HDL-c, and non-HDL-c/HDL-c values than the patients in the NAION group with visual acuity >20/200 (P=0.032, 0.025, 0.032, respectively). The values for the atherogenic indices were higher in NAION patients with bilateral sequential involvement in comparison to those with unilateral involvement (P=0.271, 0.127, 0.197, 0.128, 0.127, respectively). CONCLUSION: The study reveals a relationship between NAION and the non-traditional lipid ratios. Atherogenic indices may predict the visual loss severity and second eye involvement in patients with NAION.