This is a retrospective population-based cohort study to evaluate the risk of developing optic neuropathy from the use of amiodarone in Taiwan. Over a five-year period (2005-2009), there were 6175 amiodarone-treated patients with 24,700 patients taken as controls. After a mean follow-up period of 688 days, optic neuropathy developed in 17 amiodarone patients (0.3%) and 30 control patients (0.1%) – this is statistically significant. Interestingly the risk is not increased with greater daily dose. However, male gender and longer duration were risk factors. Although amiodarone demonstrates a statistically significant greater risk of developing optic neuropathy compared to controls, the low incidence of 0.3% and lack of treatment options mean that screening is likely to be cost-ineffective.