Vascular origin in acute transient visual disturbance: A prospective study

Area of Science:

• Neurology
• Ophthalmology
• Vascular Medicine

Background:

• Transient visual disturbances (TVDs) can indicate serious underlying vascular conditions.
• Accurate and timely diagnosis of TVDs is crucial for appropriate patient management.
• Current diagnostic methods may have limitations in rapidly identifying the origin of TVDs.

Purpose of the Study:

• To validate a clinical score for predicting the vascular origin of TVDs in patients presenting without diplopia.
• To assess the score's performance in distinguishing ischemic TVDs from nonvascular causes.
• To determine the score's utility in guiding neurovascular evaluation.

Main Methods:

• Prospective study involving patients in an ophthalmology emergency department and a transient ischemic attack (TIA) clinic.
• Clinical evaluation included a tailored questionnaire, brain, vascular, and ophthalmologic investigations.
• A nine-point clinical score was derived and externally validated in an independent cohort.

Main Results:

• An ischemic origin for TVDs was identified in 45% of the derivation cohort.
• The nine-point score demonstrated good discriminative power (c-statistic = 0.82) in identifying ischemic origin.
• The score was successfully replicated in the validation cohort (c-statistic = 0.75), with a score ≥ 4 showing 85% sensitivity and 52% specificity.

Conclusions:

• The developed clinical score can assist in predicting the vascular origin of transient visual disturbances.
• Ophthalmologic evaluation, while important, should not delay essential neurovascular assessment if not immediately available.
• The findings support the use of this score in clinical practice for managing patients with TVDs.