Amaurosis fugax carries approximately half the subsequent stroke risk of TIA, suggesting these conditions have distinct natural histories and patients with amaurosis fugax would likely benefit from distinct diagnostic evaluation and individualized risk-benefit assessments beyond simple application of TIA-derived diagnostic and treatment protocols.
Key Findings
Results
Patients with amaurosis fugax had significantly lower 300-day cumulative ischemic stroke probabilities compared to matched TIA patients.
300-day cumulative stroke probability was 1.5% for amaurosis fugax versus 3.3% for TIA patients
Hazard ratio was 0.49 (95% CI 0.28–0.84), p = 0.01
After propensity-score matching, 4,350 amaurosis fugax patients were compared to 8,698 TIA patients
Matching was performed on 25 covariates using a 1:2 ratio from an initial cohort of 131,791 patients identified via the Nationwide Readmissions Database (2016–2022)
Results
The risk of disabling ischemic stroke readmission was also significantly lower in amaurosis fugax patients compared to TIA patients.
Disabling stroke hazard ratio was 0.47 (95% CI 0.22–0.99), p = 0.048
Disabling ischemic stroke was a secondary outcome assessed over 300 days
The magnitude of risk reduction for disabling stroke was similar to that for any ischemic stroke (approximately half the risk)
Results
Non-elective readmission rates were significantly lower in amaurosis fugax patients than in TIA patients.
Hazard ratio for non-elective readmission was 0.84 (95% CI 0.73–0.98), p = 0.023
Non-elective readmission was assessed as an additional 300-day outcome
This finding suggests a generally lower burden of adverse events following amaurosis fugax compared to TIA
Results
Rates of major hemorrhage, intracranial hemorrhage, and death did not differ significantly between amaurosis fugax and TIA patients.
No statistically significant differences were found between groups for major hemorrhage, intracranial hemorrhage, or death over 300 days
The absence of excess hemorrhage or death in amaurosis fugax patients indicates the lower stroke risk is not offset by other serious harms
These outcomes were among the additional 300-day outcomes evaluated
Background
Amaurosis fugax is conventionally classified as a TIA subtype, yet landmark TIA management trials did not specifically enroll patients with amaurosis fugax.
Clinicians frequently extrapolate TIA trial data to amaurosis fugax, potentially exposing patients to suboptimal diagnostic and treatment plans
The study used non-elective hospitalizations with a primary diagnosis of TIA or amaurosis fugax from the Nationwide Readmissions Database covering 2016–2022
The authors argue these conditions have distinct natural histories based on their findings
Methods
The study identified a total of 131,791 patients with primary diagnoses of TIA or amaurosis fugax before matching.
Data were drawn from the Nationwide Readmissions Database for the years 2016–2022
Only non-elective hospitalizations were included
After propensity-score matching on 25 covariates, 4,350 amaurosis fugax and 8,698 TIA patients were retained for analysis
What This Means
This research suggests that amaurosis fugax — a temporary loss of vision in one eye caused by reduced blood flow — carries about half the risk of a subsequent stroke compared to a transient ischemic attack (TIA, or 'mini-stroke'), despite the two conditions traditionally being grouped together in clinical guidelines. Using a large U.S. hospital database covering over 130,000 patients from 2016 to 2022, researchers carefully matched amaurosis fugax patients to similar TIA patients and tracked outcomes over roughly 10 months. They found that patients with amaurosis fugax had a 1.5% chance of having a stroke within 300 days, compared to 3.3% for TIA patients — a roughly 50% lower risk. The risk of a disabling stroke was similarly reduced.
Importantly, this lower stroke risk in amaurosis fugax was not accompanied by any increase in serious bleeding events or death, suggesting the two conditions truly have different underlying risk profiles rather than different tradeoffs. Non-elective hospital readmissions were also lower in the amaurosis fugax group, pointing to an overall lower burden of serious adverse events after this diagnosis.
This research suggests that the current clinical practice of applying TIA treatment and diagnostic protocols directly to amaurosis fugax patients may not be appropriate, since the landmark trials that established TIA management guidelines did not specifically include amaurosis fugax patients. The findings indicate that patients with amaurosis fugax may benefit from tailored diagnostic workups and individualized treatment decisions, rather than automatic application of TIA-derived protocols. Further research is needed to determine what the optimal management strategy for amaurosis fugax specifically should look like.
Chen H, Huang A, Franco Castro L, McIntyre M, Lakhani D, Malhotra A, et al.. (2026). Risk of ischemic stroke following amaurosis fugax versus transient ischemic attack.. Journal of neurology. https://doi.org/10.1007/s00415-026-14080-w