Can Moyamoya Disease Affect Vision?

Moyamoya disease is a rare, progressive cerebrovascular disorder characterized by the narrowing or blockage of major arteries at the base of the brain. While this condition primarily impacts blood flow to the brain and increases the risk of ischemic stroke or hemorrhagic events, it typically does not directly impair vision.

Understanding Moyamoya and Its Neurological Impact

The hallmark of moyamoya disease is the gradual occlusion of the internal carotid arteries and their major branches. As these vessels narrow, the brain attempts to compensate by forming a network of tiny collateral blood vessels that resemble a "puff of smoke" on imaging—hence the name "moyamoya," which means "puff of smoke" in Japanese.

These vascular changes mainly lead to neurological complications such as transient ischemic attacks (TIAs), strokes, seizures, or cognitive impairments, especially in children and young adults. However, direct damage to the optic nerves or visual pathways due to moyamoya itself is uncommon.

When Vision Problems Do Occur: Possible Underlying Causes

Although moyamoya disease doesn't usually cause vision loss, patients who experience visual disturbances should not dismiss them. It's important to investigate other potential causes that may coexist or mimic symptoms.

Common eye-related conditions such as myopia (nearsightedness), glaucoma, cataracts, or retinal disorders are more likely culprits for decreased visual acuity. A comprehensive eye examination by an ophthalmologist can help rule out these issues.

Could a Brain Tumor Be the Real Cause?

In some cases, vision problems may stem from structural abnormalities in the brain rather than moyamoya itself. For instance, tumors located in or near the sellar region—such as pituitary adenomas—can compress the optic chiasm, leading to visual field defects like bitemporal hemianopsia.

Neuroimaging plays a crucial role in identifying such lesions. A brain MRI with contrast enhancement is highly recommended for anyone with unexplained vision changes, even if they have been diagnosed with moyamoya disease. This helps differentiate between vascular complications and space-occupying masses.

Managing Symptoms and Ensuring Early Diagnosis

Patients with moyamoya should maintain regular follow-ups with both neurologists and ophthalmologists, especially if new sensory or motor symptoms arise. Early detection of secondary conditions ensures timely intervention and better long-term outcomes.

Treatment for moyamoya often involves surgical revascularization procedures to restore adequate cerebral blood flow and reduce stroke risk. However, any concurrent vision issues must be evaluated independently and managed according to their specific etiology.

In summary, while moyamoya disease does not directly affect eyesight, associated neurological or structural conditions might. Therefore, a multidisciplinary approach involving neurology, neurosurgery, and ophthalmology is essential for comprehensive patient care.