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Atrial Fibrillation: An Underestimated Cause of Ischemic Monocular Visual Loss?

Angeliki Zarkali1, Suk Fun Cheng2, Agnes Dados1

  • 1Hyperacute Stroke Unit, University College London Hospital, United Kingdom.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|April 3, 2019
PubMed

Insights

Atrial fibrillation (AF) affects 9% of patients with ischemic monocular blindness, often going undetected. Management of known AF was suboptimal, with many eligible patients not receiving anticoagulation.

Area of Science:

  • Cardiology
  • Neurology
  • Ophthalmology

Background:

  • Atrial fibrillation (AF) is a primary cause of ischemic stroke and TIA.
  • Retinal ischemic monocular blindness is typically linked to carotid artery disease (CAS), with less focus on AF screening.
  • This study investigated the prevalence of AF in patients experiencing ischemic monocular blindness.

Purpose of the Study:

  • To determine the prevalence of atrial fibrillation (AF) in patients presenting with ischemic monocular blindness.
  • To assess the diagnostic yield of cardiac monitoring in this patient group.
  • To evaluate the management of anticoagulation in AF patients with ischemic monocular blindness.

Main Methods:

  • Retrospective review of 400 consecutive patients presenting with ischemic monocular blindness to a TIA clinic (Jan 2014-Oct 2016).
  • Analysis included patient demographics, event type (transient vs. permanent), cardiac monitoring, carotid imaging, and AF diagnosis.
  • Comparison of comorbidities and anticoagulation status between AF and non-AF groups.

Main Results:

  • Of 400 patients, 9% were diagnosed with AF; 14% had significant ipsilateral carotid artery disease (CAS).
  • Only 53% of patients underwent prolonged cardiac monitoring, suggesting the 9% AF prevalence is an underestimate.
  • Among diagnosed AF patients, only 55% were on anticoagulation, despite eligibility (CHADVASC2 score ≥1).
  • AF patients exhibited higher rates of hypertension, prior TIA, prior stroke, and ischemic heart disease.

Conclusions:

  • A significant proportion of patients with ischemic monocular blindness have undiagnosed or undertreated atrial fibrillation.
  • Current diagnostic strategies may underestimate AF prevalence due to limited cardiac monitoring.
  • Anticoagulation management for AF in this cohort is suboptimal, increasing stroke risk.
Abstract

Keywords:
Ischemic monocular visual lossatrial fibrillationretinal artery occlusiontransient ischemic attack

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