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Practical clinical approaches to functional visual loss.
Celia S Chen1, Andrew W Lee, Arthur Karagiannis
1Department of Ophthalmology & Visual Sciences, University of Adelaide, North Terrace, Adelaide, South Australia, Australia. celiachen@bigpond.com
Summary
Functional visual loss (FVL) is diagnosed using specific clinical tests, avoiding expensive imaging. Early, confident diagnosis and understanding management are key for patient recovery.
Area of Science:
- Ophthalmology
- Neurology
- Psychiatry
Background:
- Functional visual loss (FVL) presents as subnormal vision without identifiable pathology.
- It exists on a spectrum from malingering to hysteria.
- FVL can impose significant financial burdens due to evaluation and disability claims.
Purpose of the Study:
- To offer a practical approach for examining patients with suspected functional visual loss.
- To guide clinicians in accurate and early diagnosis of FVL.
- To reduce diagnostic costs by emphasizing clinical tests over imaging.
Main Methods:
- High index of suspicion is crucial for initial assessment.
- Performance of a few simple, well-learned clinical tests.
- Avoiding unnecessary expensive imaging like MRI.
Main Results:
- Simple clinical tests can demonstrate vision better than alleged.
- Effective clinical testing can obviate the need for costly investigations.
- Properly applied tests can significantly reduce diagnostic costs.
Conclusions:
- Accurate and early diagnosis of FVL relies on clinical suspicion and specific tests.
- Management should be empathetic, as confrontation is rarely effective.
- Emphasizing a good prognosis facilitates patient recovery and offers a positive outlook.