In late December Dara Lehon woke up with what seemed like the telltale signs of a migraine’s onset. She experiences ocular auras with them and wasn’t surprised to see spots floating in her eye and blurred vision. As days passed and the migraine subsided, she noticed the spots and blurriness remained in her left eye. She soon received a shocking diagnosis.
“The doctor looked at (my eye) and said, ‘So you’ve had a stroke.’ And I looked at him blankly saying, ‘I don’t understand,’” Lehon, 47, of New York City, recalled to TODAY. “He said ‘It’s called a retinal artery occlusion and it’s considered a stroke of the eye.’”
A migraine — then a surprise diagnosis
When Lehon returned home from vacation in Costa Rica in December 2021, she felt a migraine coming on, including an ocular aura. The spots and blurriness remained even after the migraine ended. Yet she felt wary of going to the emergency room during the omicron surge.
“I don’t stress out about it too much because I’ve had (migraines) since my 20s,” she said. “I saw some weird spots in my eyes and it looks a little blurry and I figured I was tired.”She mentioned the eye spots to a few friends. One suggested that Lehon had a detached retina. So she visited an eye clinic in January that sent her to a retina specialist.
“There looked like there was bleeding in the eye,” she said. “(Doctors) didn’t want to opine on what it was until the retina specialist saw it.”
Dr. Alexander Barash knew exactly what it was — an eye stroke
“The typical way this presents is painless vision loss. It is in one eye — and not both at the same time — and piece of their vision is blocked. People say ‘hazy’ or ‘blurry,’” Barash, a vitreoretinal surgeon at New York Eye and Ear Infirmary of Mount Sinai, told TODAY. “This is a systemic problem that happens to occur in the eye.”
People experience eye stroke for many of the same reasons they experience stroke. Having high blood pressure, high cholesterol and diabetes make people at a greater risk of stroke. But Lehon is relatively young, active and didn’t have any conditions that predisposed her to stroke.
“This is wild. I can’t believe this is happening to me. It didn’t compute,” Lehon said. “I have low blood pressure if anything. I’m active. I’m a pescatarian. I run.”
Much like stroke needs to be treated right away, eye stroke requires immediate medical attention. Barash sent her to the emergency room so Lehon could undergo a complete examination to determine why she experienced eye stroke.
“They wanted to make sure there was no brain damage,” she said.
She underwent a CT scan, MRI and blood tests to look for clotting disorders or other reasons to explain it. Because she didn’t go to the hospital immediately after she experience the eye spots and blurriness, doctors couldn’t do anything to treat it.
“The damage was already done,” she said. “It basically killed the cells.”
The last test she had was an echocardiogram bubble study, where saline with bubbles is injected into the vein and the echocardiogram shows how bubbles move. If it crosses from the right to left side of the heart a patient might have a patent foramen ovale (PFO), a hole in the heart.
“I saw the bubbles going back and forth and I was like, ‘Oh I guess that’s what a heart does,’” Lehon said. “It doesn’t necessarily do that unless it has a hole in it.”
What is a PFO and how is it treated?
When babies develop in utero there’s a hole in their heart that normally closes shortly after birth. About 1/3 of adults still have the hole, a PFO, that is normally harmless, Dr. Barry Love said. Most people never know they have one. Sometimes when a young person experiences stroke, doctors discover the PFO as the potential cause.
“People who have a stroke for no good reason we find the PFO more often than we would find in the general population and they’re also much more likely to have a second event,” Love, the director of the congenital cardiac catheterization program at the Mount Sinai Hospital, told TODAY. “A little clot that forms in the legs that otherwise would go to the heart and go to the lungs and be harmlessly filtered out in this case goes across to the left side of the heart and goes unfiltered anywhere in the body.”
When the clot goes to the eye or the brain it can cause stroke.
“The eye itself is actually part of the brain and if (a clot) blocks an area of blood flow you get immediate vision loss,” Love said. “If it breaks up … the flow is able to go around the vision is then restored.”
After doctors discovered Lehon’s PFO, they knew they needed to fix it so she wouldn’t experience another stroke. Using a catheter threaded through a vein located at the top of the leg up to the heart, Love placed a “little plug” in the hole to close it.
“Then the tissue of the heart grows over it to seal it up,” he said.
While a PFO sounds scary, Love says most people don’t need to worry.
“These events are still relatively rare for young people,” he said.
Life after eye stroke
Lehon has been slowly building up her endurance. It’s been a slower recovery than she’s experienced before.
“I’ve had plenty of injuries. I’ve had knee surgery before,” she said. “But having something done to your heart is quite different for me.”
Running has been much harder and she’s been surprised by how easily she gets tired. Recently, she ran four miles, one of her longest and fastest runs since her stroke but felt exhausted for next two days.
“I use running as one of my gauges. I’ve been increasing my mileage basically every week,” Lehon said. “I get out of breath much sooner. It’s harder to rebuild.”
Still she feels pleased by how far she’s come.
“It’s also pretty amazing when I think about it. It’s really only been three months and I’m running around,” she said. “For the first month, at least, I felt my heart quite a bit. You can feel palpitations.”
While she still has blurry spots in her eye, she doesn’t notice it as much.
“I’m getting used to it and adapting,” she said. “It takes time.”
While rare, she hopes to raise awareness of eye stroke so that if someone suddenly sees spots or has blurry vision they seek help.
“There was no way I would have known eye stroke was,” she said. “Calling a retinal artery occlusion a stroke actually helps elevate awareness about it and can potentially help people save their eyesight.”