This last year has been a particularly busy one in the field of neuro-ophthalmology. The publication of the second, important, randomized multicentered trial in neuro-ophthalmology highlights the power of randomized trials to answer important clinical questions. This and other publications emphasize the pivotal role of vascular pathophysiology in production of neuro-ophthalmic disease. The progress in our understanding of mechanisms of vascular obstruction, risk factors for vascular disease and ocular manifestations, as well as technical advances in our approach to patients with vascular problems have continued the broad-front advancement in neuro-ophthalmology.