Diagnostic Strategies in the Management of Unexplained Visual Loss

Abstract

In the investigation of visual loss from anterior visual pathway disease, it is imperative to differentiate the infrequent compressive from the much more common noncompressive lesions. To determine how relatively low-cost, risk-free, but error-prone visual field examination (VF) and high-cost, risk-prone, but accurate CT Scan (CT) and cerebral angiography (Angio) can be cost-effectively utilized to solve this diagnostic problem, the authors have developed a decision making model for the analysis of three management strategies. The visual field examination precedes and determines the use of neuroradiologic studies in Strategy A (VF-CT-Angio), whereas it follows the neuroradiologic studies in Strategies B (CT-VF-Angio) and C (CT-Angio-VF). The visual field-determined strategy (A) proved most cost-effective, based upon an estimated 6% or lower relative prevalence of chiasmal compressive lesions, a negligible risk in delaying their diagnosis, and a sensitive method of visual field examination. At a visual field sensitivity to chiasmal defects of 84% and a specificity of 88%, Strategy A annually saves $4 million over Strategy B and $27 million over Strategy C. At lower levels of perimetric accuracy, Strategy B is the most cost-effective approach. Strategy C is never cost-effective.

Unexplained Visual Loss; Different Etiologies, Costs and Diagnostic Guideline Proposal

“…MSOR.000549. 2 (5).2019 abnormality examined by previous ophthalmologist were recruited in the study. The following data were collected from the medical records of patients: demographic information, pattern of decreased vision, initial BCVA, duration of the symptoms, time from the first visit to presentation to our clinic, number of workups done before and amount of money spent by patients as well as the expenses imposed on medical insurances for each workup.…”

“…UVL is a common problem among patients presenting to ophthalmic care services and neuro-ophthalmology clinic, which poses distress and anxiety to both patients and physicians [3,4]. It is necessary to search for any definable pathology of decreased vision before arriving at the diagnosis of functional vision loss (FVL) which is a label that affects further investigations as well as treatment strategies [5]. Scott and Egan have shown that organic etiologies account for a large proportion of UVL with more than half of the patients with FVL had concurrent organic disease [6].…”