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How urgent is the treatment of transient vision loss?
  1. Prem S Subramanian
  1. Correspondence to Dr Prem S Subramanian, Wilmer Eye Institute, 600 N Wolfe St, Woods 457, Baltimore MD 21287 USA; psubram1{at}jhmi.edu

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Amaurosis fugax, or transient monocular blindness (TMB) from an embolic phenomenon, represents an ophthalmic form of a cerebrovascular transient ischaemic attack (TIA), and it has been associated with an increased risk of hemispheric stroke. In this issue of the BJO, Naylor R et al1 describe the changes in physician behaviour after instituting a streamlined referral system for TMB patients to a TIA clinic, where optimal medical and rapid surgical treatment (where appropriate) were provided. They did not attempt to measure improved outcomes, taking them as a given based on their assessment of the recent literature, and they recommend that ophthalmologists who diagnose TMB should start immediate antiplatelet and statin therapy in all cases, with referral within the week for medical treatment and surgical consultation for carotid endarterectomy (CEA). In their system, patients waited no longer than 7 days after referral for evaluation and were seen sooner if warranted by risk assessment. They found that ophthalmologists were willing to refer …

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