The following is a summary of “Yield of Investigations in Young Patients Presenting with Transient Monocular Vision Loss: A Prospective Study,” published in the September 2023 issue of Opthalmology by Sverdlichenko et al.

The need for a thorough systemic evaluation in young adults with transient monocular vision loss (TMVL) is uncertain compared to older adults. Researchers performed a prospective study to assess the diagnostic yield of investigations in patients under 45 with TMVL.

They enrolled young TMVL patients at a university-affiliated neuro-ophthalmology clinic, referring all participants for neuroimaging (CT or MR angiography of the entire carotid tree and brain MRI) and cardiac assessments (transesophageal echocardiogram and 2-week Holter monitoring).

The results showed 20 subjects with TMVL had a mean age of 33.1 ± 8.2 years, with 16/20 being women. Migraines were the most common finding in 5/20 cases (25%), and 25% of patients experienced headaches during their visual loss episodes in medical histories. Of the 17 subjects who completed neuroimaging, 1 had fibromuscular dysplasia, and this patient also had headaches during their symptoms. Of the 13 patients who completed echocardiography, 2 had patent foramen ovale. Overall, 3 /20 participants (15%, 95% CI 3-38%) had abnormal findings related to their TMVL. Aspirin treatment was initiated in 2/3 of patients following investigations.

They concluded that 15% of young patients with TMVL had abnormal findings on further investigations, suggesting that neuroimaging and cardiac workups are warranted.

Source: ajo.com/article/S0002-9394(23)00359-8/fulltext