AAO 2024: Transient vision loss with Alexander Fein, MD

Alexander Fein, MD, spoke with the Eye Care Network to share how to approach a patient presenting with transient vision loss, what this type of vision loss can mean, and what additional testing might be needed to determine the best plan for care.

This transcript has been lightly edited for clarity.

Alexander Fein, MD: Hi, I'm Alexander Fein. I'm a neuro-ophthalmologist at the Stein Eye Institute and Doheny Eye Institute at UCLA. My topic was to talk about the what to do when you have a patient with transient vision loss and their examination is normal, and they come to your clinic a couple of days later. And really the key point is, is to try and differentiate, was it monocular or binocular, and particularly to determine if you have any suspicion for if it was a vascular event. Factors of that would be if it was a monocular event, occurring only in one eye, of vision loss, classically, with a curtain coming down, but patients might not be able to describe it that way. A vascular monocular vision loss is a stroke equivalent or a TIA equivalent, and should be treated as such. These patients need to be seen urgently or emergently in the emergency room or a TIA clinic to get urgent vessel imaging and MRI in order to make sure that we rule out any form of stroke or TIA and get them on the proper antiplatelet or anticoagulant medication. They should also get lab tests for hemoglobin, A1c and lipid panel in order to modify their vascular risk factors, make sure they don't have diabetes or hyperlipidemia, so you can get them on the right medication to prevent further attacks.

The name of the game is secondary prevention once they come in with this episode. I think often the challenges come from getting the right history. Often patients have trouble differentiating between monocular and binocular symptoms, and this vision loss that you might be concerned about may just be a migraine aura, but often patients will have difficulty determining whether it was just in 1 eye or both eyes. That being said, if you have any level of suspicion that this was a vascular event, better to be safe than sorry and get the imaging, get them to the emergency room, so they can be seen by the emergency department in vascular neurology. The important thing to know is that, just like time is brain, time is retina. The longer that they, the more that they get these episodes, the more that damage can be done. And the thing that you should know is that transient vision loss in 1 eye is the same as a transient ischemic attack in the brain, and it portends further visual loss in the future.