Functional Visual Loss

Kathol, Roger G.; Cox, Terry A.; Corbett, James J.; Thompson, H. Stanley

doi:10.1001/archopht.1983.01040010729005

Cited by 82 publications

(7 citation statements)

References 9 publications

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“…In the absence of an organic disorder, patients were reported to experience an improvement of 45% to 78% in the vision and visual symptoms with simple reassurance, during 6 to 8 weeks of follow-up, without any special psychiatric treatment or placebo treatment. [ 16 – 19 ] However, in this case, the patient's defect became chronic over more than 6 months. The patient is a nonregular employee and is of a lower socioeconomic status.…”

Section: Discussionmentioning

confidence: 79%

“…Several authors emphasized the role of simple reassurance in the treatment of many patients with functional visual disturbances, and nonspecific treatments are discouraged. [ 3 , 16 ] Kathol et al [ 16 ] reported that reassurance was more likely to recover visual function than nonspecific treatments such as glasses or eye drops. Lim et al [ 3 ] reported that resolution occurred in over half of the patients.…”

Section: Discussionmentioning

confidence: 99%

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An atypical presentation of functional visual loss

Chung

Jin²,

Kang³

et al. 2017

Medicine

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Rationale:Functional visual loss (FVL) can manifest as various symptoms. Decreased distant visual acuity is the most common symptom and visual field defect is the second most common symptom. Hemianopsia is rarely reported. In an atypical situation of FVL, it is important to prove that no organic pathology exists, through detailed history taking and appropriate examinations.Patient concerns:This review presents the case of a 48-year-old male patient presented with decreased bilateral visual acuity and visual field defect after a traffic accident 3 weeks ago. Visual field test showed atypical features of FVL in which visual field change from binasal hemianopsia to left homonymous hemianopsia.Diagnosis:The best corrected visual acuities (BCVA) were 20/63 in both eyes and binasal hemianopsia was observed on a Humphrey visual field test. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed no abnormalities in the brain and optic chiasm. Two weeks after presentation, however, the patient's visual field defect changed from binasal hemianopsia to left homonymous hemianopsia. We diagnosed it as FVL due to conversion disorder.Intervention and outcomes:We decided to cooperate with a psychiatrist for cognitive behavioral therapy and the patient is under observation.Lessons:Binasal hemianopsia and homonymous hemianopsia are rare; however, it may occur simultaneously in 1 patient with FVL. The possibility of FVL should be considered when there is atypical visual field defect and no organic abnormalities are observed. Repeated Humphrey field test and VEP may be helpful in diagnosis of FVL.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

An atypical presentation of functional visual loss

Chung

Jin²,

Kang³

et al. 2017

Medicine

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“…As a result, a diagnosis of NOVL should prompt clinicians to investigate possible triggers and associated psychopathologies that may have precipitated the child's ophthalmologic symptoms. Psychiatric conditions, such as conversion disorder, are also implicated as a cause of NOVL, however, psychiatric therapeutic management has not been shown to improve outcome or decrease the period of time the child experiences the visual deficit [2,13–15]. In a small percentage of children with NOVL, there is a history of physical or sexual abuse [2,12].…”

Section: Discussionmentioning

confidence: 99%

“…Psychotherapy is rarely indicated and has not been shown to improve outcome [2,14,15]. However, in situations where psychotherapy is specifically desired or is likely to confer a clear benefit to the patient, it should be discussed with the family as well as the primary care physician.…”

Section: Discussionmentioning

confidence: 99%

Tip of iceberg: when unusual vision complaints with a normal examination prompt a closer look

Weiss

Chang²,

Cavuoto³

2014

Clinical Case Reports

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“…The suspicion of malingering was based on the discrepancies between VA i and clinical findings. After VA i , best-performed VA or VA aset (visual acuity after simulation examination techniques: SETs) was assessed after certain technical procedures and behavioral observations, which use fogging, dissociation, and fixation techniques employed for detection of malingering included pupillary light reflexes, grimacing in front of the subject,[13] prism dissociation test,[78] polarizing lenses,[910] distance test,[69] bar-reading test (Javal-Cuignet),[69] two-perpendicular cylinder test,[6] Harlan test,[69] VA repetition test,[61611] hand shaking test,[6] and a new optotype chart introduced by Mojon et al . [12] VA i and the VA aset were checked by the experienced clinician (SG) unaware of the VA i. , and included in the study if the same results were obtained.…”

Section: Methodsmentioning

confidence: 99%

Retinal nerve fiber layer thickness analysis in suspected malingerers with optic disc temporal pallor

Civelekler

Halili

Gündoğan

et al. 2009

Indian J Ophthalmol

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Purpose:To investigate the value of temporal retinal nerve fiber layer (RNFLtemporal) thickness in the prediction of malingering.Materials and Methods:This prospective, cross-sectional study was conducted on 33 military conscripts with optic disc temporal pallor (ODTP) and 33 age-and sex-matched healthy controls. Initial visual acuity (VAi) and visual acuity after simulation examination techniques (VAaset) were assessed. The subjects whose VAaset were two or more lines higher than VAi were determined as malingerers. Thickness of the peripapillary RNFL was determined with OCT (Stratus OCT™, Carl Zeiss Meditec, Inc.). RNFLtemporal thickness of the subjects were categorized into one of the 1+ to 4+ groups according to 50% confidence interval (CI), 25% CI and 5% CI values which were assessed in the control group. The VAs were converted to LogMAR-VAs for statistical comparisons.Results:A significant difference was found only in the temporal quadrant of RNFL thickness in subjects with ODTP (P=0.002). Mean LogMAR-VA increased significantly after SETs (P<0.001). Sensitivity, specificity, positive and negative predictive values of categorized RNFLtemporal thickness in diagnosing malingering were 84.6%, 75.0%, 68.8%, 88.2%, respectively. ROC curve showed that RNFLtemporal thickness of 67.5 μm is a significant cut-off point in determining malingering (P=0.001, area under the curve:0.862). The correlations between LogMAR-VAs and RNFLtemporal thicknesses were significant; the correlation coefficient for LogMAR-VAi was lower than the correlation for LogMAR-VAaset (r=−0.447, P=0.009 for LogMAR-VAi; r=−0.676, P<0.001 for LogMAR-VAaset).Conclusions:RNFLtemporal thickness assessment may be a valuable tool in determining malingering in subjects with ODTP objectively.

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Functional Visual Loss

Cited by 82 publications

References 9 publications

An atypical presentation of functional visual loss

An atypical presentation of functional visual loss

Tip of iceberg: when unusual vision complaints with a normal examination prompt a closer look

Retinal nerve fiber layer thickness analysis in suspected malingerers with optic disc temporal pallor

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