Transient monocular vision loss (TMVL) is often associated with abnormal findings in older adults, notably embolism, but this small study found that more than 15% of young adults with TMVL also had cardiac or neurologic abnormalities that could warrant intervention.
Study Design
This prospective cohort study evaluated 20 young adult patients (17–44 years of age) with TMVL who presented to a single neuro-ophthalmology center to better understand the likelihood of abnormal findings associated with TMVL in younger individuals. All patients underwent neuroimaging and cardiac investigations.
Outcomes
In more than half of the patients, no abnormal findings were noted. Three of the 20 patients had at least one abnormal finding that suggested an embolic source of their TMVL, including 1 patient with diffusion restriction on brain MRI and fibromuscular dysplasia and 2 patients with patent foramen ovale (PFO). Two patients also showed abnormalities on ECG. Five patients reported headaches during their vision loss.
Limitations
This study is limited by its small sample size. In addition, the underlying conditions found may not necessarily have contributed to the TMVL. Two of the 3 patients with abnormalities were treated with anti-platelets, but this study does not share whether the TMVL ceased to occur post-treatment; a recurrence of symptoms would point toward the need for further investigation into the cause and a potential change in medical management. However, this study's objective was to investigate the likelihood of abnormal findings in patients with TMVL, not TMVL management options.
Clinical Significance
As working up TMVL in young patients can be considered low yield by many clinicians, the existing literature may underestimate the true incidence of underlying causes of TMVL in younger individuals. This study, however, highlights that young adults with TMVL can have abnormal findings on neuroimaging and cardiac investigations that warrant further work-up, whether these findings indicate potential causes or not. For example, 2 patients had PFO. Although PFO alone is not thought to be a risk for transient ischemic attack or stroke, it can pose significant risk in combination with atrial septal aneurysm or substantial shunt size. Some literature reports a PFO prevalence of 60% in patients with cryptogenic stroke.1 Hence, the presence of PFO in individuals with TMVL could be a significant finding. Also, several individuals reported headaches associated with TMVL, which may be diagnosed as retinal migraine but should be a diagnosis of exclusion. Further studies into young-adult TMVL are needed to establish more solid guidelines on best practices for working up and managing these patients.
Financial Disclosures: Dr. Dana Albreiki discloses no financial relationships.
Reference:
1 Poli S et al. Neurological Research and Practice. 2021;3(16).