Neurovascular Causes of Acute Monocular Visual Loss

• Published in: Current treatment options in cardiovascular medicine Vol. 22; no. 10; p. 27
• Main Authors: Truong-Le, Melanie, Mallery, Robert M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2020; Springer Nature B.V
• Subjects: Automation; Cardiology; Carotid arteries; Cerebrovascular Disease and Stroke (S Silverman; Cornea; Edema; Hypotension; Ischemia; Localization; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Migraine; Optic nerve; Pharmacists; Retina; Retinal detachment; Section Editor; Steroids; Stroke; Tomography; Topical Collection on Cerebrovascular Disease and Stroke; Vein & artery diseases; Visual acuity; Central Retinal Artery Occlusion (CRAO); Amaurosis fugax; Ischemic optic neuropathy; Giant cell arteritis; Paracentral Acute Middle Maculopathy (PAMM); Benign retinal vasospasm
• ISSN: 1092-8464; 1534-3189
• DOI: 10.1007/s11936-020-00829-7

Purpose of review Acute monocular visual loss may result from a diverse set of neurovascular and systemic disorders and requires urgent evaluation. The goal of this review is to describe the most current understanding of the clinical features, pathophysiology, diagnosis, and treatment of these disorders. Recent findings 1. Acute central retinal artery occlusion (CRAO) should be treated as an equivalent to acute ischemic stroke. 2. Several recent clinical trials are evaluating the treatment of non-arteritic anterior ischemic optic neuropathy (NAION). 3. Tocilizumab is emerging as a first-line steroid-sparing immunomodulatory therapy for the treatment of giant cell arteritis (GCA). 4. Optical coherence tomography (OCT) imaging of the retina has led to the appreciation that retinal capillary ischemia in the form of paracentral acute middle maculopathy (PAMM) is a distinct form of acute monocular visual loss with relatively normal-appearing fundus examination and good prognosis for recovery. Summary Accurate diagnosis and timely treatment of disorders resulting in acute monocular visual loss may reduce the likelihood of additional visual and neurologic complications.