Yield of Investigations in Young Patients Presenting With Transient Monocular Vision Loss: A Prospective Study

Abstract

It is unclear whether transient monocular vision loss (TMVL) warrants the same thorough systemic evaluation for potential embolic sources in young adults as it does in older adults. The objective of the present study was to evaluate the yield of investigations in patients under 45 years old presenting with TMVL. Prospective cohort study. Young patients with TMVL presenting to a university-affiliated neuro-ophthalmology clinic were included. All included patient were referred for neuroimaging (CT or MR angiography of entire carotid tree and MRI of the brain) and cardiac investigations (transesophageal echocardiogram and 2 weeks Holter monitoring). Twenty participants with TMVL were included in the study. The mean age was 33.1 ± 8.2 years and 16/20 were women. The most common finding on past medical history was migraines, in 5 out of 20 cases (25%), and 25% of patients had headaches during their visual loss. Out of 17 participants who completed neuroimaging, 1 had fibromuscular dysplasia - this patient also experienced headaches during their symptoms. Two out of 13 patients who completed echocardiography had patent foramen ovale. Overall, 3 out of 20 participants (15%, 95% CI 3-38%) had abnormal findings associated with their TMVL. Aspirin treatment was initiated in 2 out of 3 patients following investigations. In our cohort of young patients presenting with TMVL, 15% of patients had abnormal findings on further investigations. We recommend that young patients presenting with TMVL be referred for neuroimaging and cardiac workup so that appropriate treatments can be initiated to prevent future complications. Headaches during the vision loss may not always indicate a benign cause, and retinal migraine should be a diagnosis of exclusion.