Medically unexplained visual loss in adult patients

Area of Science:

• Ophthalmology
• Neuroscience
• Psychiatry

Background:

• Medically unexplained visual loss is a diagnostic challenge.
• Functional visual loss (FVL) is often linked to psychosocial factors.
• Distinguishing FVL from organic visual loss requires careful evaluation.

Purpose of the Study:

• To review the investigation and management of patients with visual loss without organic pathology.
• To discuss the diagnostic utility of various electrophysiological and imaging techniques.
• To explore treatment strategies for FVL based on existing literature.

Main Methods:

• Review of recent literature on functional visual loss and related conditions.
• Analysis of the role of visually evoked potentials, multifocal electroretinography, and ocular coherence tomography.
• Consideration of differential diagnoses, including cortical visual loss.

Main Results:

• The term 'medically unexplained visual loss' is discouraged; 'functional visual loss' is preferred once organic causes are excluded.
• Visually evoked potentials have limitations in estimating objective visual acuity.
• Advanced imaging and electrophysiology can detect occult macular pathology.
• Cortical visual loss may be misdiagnosed as FVL.

Conclusions:

• Diagnosing FVL requires vigilance and should initiate treatment, not end the investigation.
• There is a lack of evidence-based guidelines for managing FVL.
• Further research is needed to adapt treatments from other functional disorders for FVL.