What is the prognosis of transient vision loss (TVL)?

Updated: May 21, 2019
  • Author: Andrew J Tatham, MD, MBA, FRCOphth, FEBO, FRCS(Ed); Chief Editor: Andrew G Lee, MD  more...
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Answer

Answer

The prognosis of transient visual disturbance is better in children than in adults (usually because nonorganic and migraine are more common in children). In a study of the long-term prognosis for adolescents and young adults with transient bilateral visual loss, Bower et al followed 13 patients aged 8-38 years who had 1 or more sudden transient attacks of bilateral blindness; none of the 13 suffered a major vascular event over a mean follow-up of 10 years. [33] The authors concluded that investigations are unlikely to reveal a cause for visual loss and that the prognosis for these patients appears benign.

When a patient presents with transient visual disturbance, the underlying cause must be ascertained and any serious treatable disorder excluded. In adults, identifying risk factors (eg, hypertension, hypercholesterolemia, and carotid artery disease) and treating systemic disease are important.

For example, if retinal emboli are found, the patient must be promptly referred for evaluation and management of cardiovascular risk factors. The Beaver Dam Eye Study found that participants with retinal emboli who present at baseline had a 3-fold higher risk of 8-year mortality from stroke than persons without emboli. [41] A prospective study showed a 43% incidence of carotid artery stenosis affecting 70% or more of the lumen among patients with transient monocular vision loss. [39]

Details of visual loss progression are important, since close to 40% of patients with altitudinal visual field loss can progress to diffuse or total vision loss. Transient vision loss also serve as a warning sign for subsequent central and branch retinal artery occlusion. [34] Although children are more likely to have a benign cause of their symptoms, some may have a serious underlying problem. For example, cases of central retinal artery occlusion and central retinal vein occlusion in children have been reported to be associated with trauma, vasculitis, antiphospholipid antibody syndrome, sickle cell disease, and leukemia. [42, 43]


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