Amaurosis fugax prevalence varies widely in vascular occlusive disorders

This study found that the prevalence and pathogenesis of amaurosis fugax in various ocular vascular occlusive disorders varies widely. It can be a presenting symptom in these disorders that always requires urgent evaluation.

Amaurosis fugax is the transient loss of vision in one eye, usually described as a period of an absolute or near absolute field defect in one eye. Very little has been written about it. Typically, authors have described symptoms of amaurosis fugax in the setting of giant cell arteritis or nonarteritic ischemic optic neuropathy.

The current study’s authors reviewed data from a large cohort of patients with various ocular vascular occlusive disorders followed prospectively.

The prevalence of amaurosis fugax was 12.18% in central retinal artery occlusion, 14.20% in branch retinal artery occlusion, 15.38% in ocular ischemic syndrome, 4.86% in central retinal vein occlusion, 37.84% in central retinal vein occlusion with cilioretinal artery occlusion, 13.43% in hemi-central retinal vein occlusion, 0.35% in branch retinal vein occlusion and 2.54% in nonarteritic anterior ischemic optic neuropathy.

The relative prevalence of amaurosis fugax was highest in giant cell arteritis with vision loss; 32.4% of patients with giant cell arteritis with ocular involvement had a history of amaurosis fugax.

The authors propose mechanisms for amaurosis fugax in each disease entity. They say that amaurosis fugax in central retinal artery occlusion, branch retinal artery occlusion and nonarteritic anterior ischemic optic neuropathy occurs mostly because of transient embolism.

What is your typical management or workup for patients who present with a history of amaurosis fugax but have a normal fundus examination?