May 2026 Recall: Clinical Approach to Monocular Vision Loss

Monocular vision loss is not just a visual emergency—it's a neurovascular crisis requiring immediate, precise diagnosis and interdisciplinary collaboration. In this comprehensive Neurology® Podcast recall, neuro-ophthalmologists Nancy Newman and Valerie Buse from Emory University dismantle long-standing myths about central retinal artery occlusion (CRAO) and non-arteritic anterior ischemic optic neuropathy (NAION). They argue that CRAO is a true stroke of the retina, demanding the same urgency as cerebral infarction—'time is retina'—and that thrombolysis, though off-label, should be considered within 4.5 hours of vision loss, especially when imaging confirms the diagnosis. The episode exposes the dangerous gap between clinical intuition and diagnostic reality: most non-ophthalmologists cannot reliably diagnose CRAO with an ophthalmoscope, and point-of-care ultrasound is dangerously unreliable. Instead, the solution lies in deploying portable fundus cameras in emergency departments, enabling remote teleophthalmology and AI-assisted interpretation. For NAION, the podcast reveals a paradigm shift: it's not a simple 'stroke' but a compartment syndrome triggered by a congenitally crowded optic nerve head, with vascular risk factors and emerging drug associations—especially GLP-1 receptor agonists—now under intense scrutiny.