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Nonorganic (psychogenic) visual loss in children: a retrospective series
Irene Toldo1, Luisa Pinello, Agnese Suppiej
1Department of Pediatrics, University of Padua, Padua, Italy. irene.toldo@unipd.it
Insights
Pediatric nonorganic visual loss typically resolves spontaneously within a year. Psychosocial stressors may contribute, but recovery predictors are not evident.
Area of Science:
- Ophthalmology
- Pediatrics
- Psychology
Background:
- Limited follow-up data exists for pediatric nonorganic visual loss.
- Prognostic factors require systematic investigation.
Purpose of the Study:
- To investigate prognostic parameters and follow-up outcomes for nonorganic visual loss in children.
- To analyze the time course and resolution of visual symptoms.
Main Methods:
- Retrospective case series of 58 pediatric patients (<16 years) with nonorganic visual loss.
- Evaluations included neurologic, ophthalmologic, orthoptic assessments, and electrophysiologic tests.
- Data collected on symptom onset, diagnosis time, duration, and psychosocial factors.
Main Results:
- Reduced visual acuity (76%) and visual field defects (48%) were primary deficits.
- Mean time to diagnosis was 3.1 months; mean symptom duration was 7.4 months.
- 93% of patients experienced complete symptom resolution, 85% within 12 months.
Conclusions:
- Nonorganic visual loss in children generally resolves spontaneously within one year.
- No major psychiatric disorders were identified post-diagnosis.
- Psychosocial stressors are common, but recovery predictors are absent.
Background:
Few studies provide follow-up information or systematic investigation of prognostic parameters of nonorganic (psychogenic) visual loss in children.
Methods:
A retrospective case series analysis was performed on 58 patients younger than 16 years old who had nonorganic visual loss and underwent at least a 3-month follow-up clinic visit and/or telephone interview between 1992 and 2007 at a single institution in Italy. All patients underwent a full neurologic, ophthalmologic, and orthoptic evaluation. Visual electrophysiologic tests were performed in many patients as part of the evaluation. Neuroimaging was performed and psychiatric referral was made only as needed. We collected data on the age at onset, time to diagnosis of nonorganic visual loss, type and duration of visual symptoms, and concomitant psychologic or psychosocial difficulties.
Results:
Visual deficits consisted mostly of reduced visual acuity (76%) and visual field defects (48%). The diagnosis of nonorganic visual loss could be reached with confidence by means of observing inconsistent performance on a wide array of visual function tests, and, in doubtful cases, by means of electrophysiologic investigations. The mean time from onset to diagnosis was 3.1 months. The mean duration of visual symptoms from reported onset to disappearance was 7.4 months. Complete resolution of all visual symptoms occurred in 93% of patients and did so within 12 months of diagnosis in 85% of patients. There was no correlation between the duration of visual symptoms and age at onset, sex, time to diagnosis, type of ocular symptoms, or presence of psychosocial or psychologic difficulties.
Conclusions:
Our study extends the follow-up information and confirms the findings of previous investigators in showing that nonorganic visual loss in children generally resolves spontaneously within 1 year and that no major psychiatric disorders are present or will appear after diagnosis. However, psychosocial stressors are often present and may predispose to this manifestation. There are no obvious predictors of rate of recovery.
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