Response: Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice
Gregory Y.Chang, Neurohospitalist, UC Davis Medical Center[email protected]
Jolene Rudell, Sacramento, CA
Submitted March 20, 2017
Drs. Sathiamoorthi and Wingerchuk described a 58-year-old woman with recurrent monocular transient smartphone blindness (TSB) upon standing. [1] The accompanying single-axial FLAIR-MRI sequence revealed >10 small vessel ischemic lesions. [1] The authors suggested TSB occurs as a normal adaptive physiologic phenomenon following each eye being exposed to a marked differential intensity of light. [1] Symptomatic photoreceptors get over-bleached by sudden brightness resulting in TSB. Transient monocular blindness following an exposure to bright light may also occur as a rare manifestation of chronic ocular ischemic syndrome from an underlying chronic internal carotid artery occlusion. [2] Delayed photoreceptor recovery from retinal vascular insufficiency is likely since a similar clinical presentation was observed in retinal venous stasis and lipemia retinalis. [3] Transient visual obscurations upon upright posture change usually occurs in the setting of disc edema from retinal-artery hypoperfusion. TSB cases were previously documented in two healthy women: a 22-year and 40-year-old. [4] This 58-year-old woman with transient blindness upon standing following smartphone use without funduscopic abnormality accompanied by small vessel infarcts on MRI suggests retinal small vessel involvement cannot be excluded. Did the authors considered fluorescein angiography to document retinal vessel involvement, despite normal funduscopic appearance, as may occur in Susac syndrome? [5]
1. Sathiamoorthi S, Wingerchuk DM. Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice. Neurology 2017;88:809-810.
2. Furlan AJ, Whisnant JP, Kearns TP. Unilateral visual loss in bright light. An unusual symptom of carotid artery occlusive disease. Arch Neurol 1979;36:675-676.
3. Kearns TP, Hollenhorst RW. Venous-stasis retinopathy of occlusive disease of the carotid artery. Proc Staff Meet Mayo Clin 1963;38:304-312.
4. Alim-Marvasti A, Bi W, Mahroo OA, Barbur JL, Plant GT. Transient Smartphone "Blindness". N Engl J Med 2016;374:2502-2504.
5. Martinet N, Fardeau C, Adam R, et al. Fluorescein and indocyanine green angiographies in Susac syndrome. Retina 2007;27:1238-1242.
For disclosures, please contact the editorial office at [email protected].
Drs. Sathiamoorthi and Wingerchuk described a 58-year-old woman with recurrent monocular transient smartphone blindness (TSB) upon standing. [1] The accompanying single-axial FLAIR-MRI sequence revealed >10 small vessel ischemic lesions. [1] The authors suggested TSB occurs as a normal adaptive physiologic phenomenon following each eye being exposed to a marked differential intensity of light. [1] Symptomatic photoreceptors get over-bleached by sudden brightness resulting in TSB. Transient monocular blindness following an exposure to bright light may also occur as a rare manifestation of chronic ocular ischemic syndrome from an underlying chronic internal carotid artery occlusion. [2] Delayed photoreceptor recovery from retinal vascular insufficiency is likely since a similar clinical presentation was observed in retinal venous stasis and lipemia retinalis. [3] Transient visual obscurations upon upright posture change usually occurs in the setting of disc edema from retinal-artery hypoperfusion. TSB cases were previously documented in two healthy women: a 22-year and 40-year-old. [4] This 58-year-old woman with transient blindness upon standing following smartphone use without funduscopic abnormality accompanied by small vessel infarcts on MRI suggests retinal small vessel involvement cannot be excluded. Did the authors considered fluorescein angiography to document retinal vessel involvement, despite normal funduscopic appearance, as may occur in Susac syndrome? [5]
1. Sathiamoorthi S, Wingerchuk DM. Transient smartphone blindness: Relevance to misdiagnosis in neurologic practice. Neurology 2017;88:809-810.
2. Furlan AJ, Whisnant JP, Kearns TP. Unilateral visual loss in bright light. An unusual symptom of carotid artery occlusive disease. Arch Neurol 1979;36:675-676.
3. Kearns TP, Hollenhorst RW. Venous-stasis retinopathy of occlusive disease of the carotid artery. Proc Staff Meet Mayo Clin 1963;38:304-312.
4. Alim-Marvasti A, Bi W, Mahroo OA, Barbur JL, Plant GT. Transient Smartphone "Blindness". N Engl J Med 2016;374:2502-2504.
5. Martinet N, Fardeau C, Adam R, et al. Fluorescein and indocyanine green angiographies in Susac syndrome. Retina 2007;27:1238-1242.
For disclosures, please contact the editorial office at [email protected].