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Medically unexplained visual loss in children and young people: an observational single site study of incidence and
M C Daniel1,2, A Coughtrey3, I Heyman3
1NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
Insights
Medically unexplained visual loss (MUVL) in children occurs at a higher rate than previously thought, with a significant portion linked to mental health issues. Recovery rates are lower, highlighting the need for psychological screening and support.
Area of Science:
- Ophthalmology
- Pediatrics
- Psychiatry
Background:
- Medically unexplained visual loss (MUVL) is a recognized condition in pediatric ophthalmology.
- Previous incidence and recovery rates for MUVL in children are not well-established.
Purpose of the Study:
- To determine the incidence of medically unexplained visual loss (MUVL) in children presenting to a pediatric eye casualty.
- To investigate potential associations between MUVL and psychological factors in pediatric patients.
Main Methods:
- A 12-month prospective study at a children's eye casualty.
- Inclusion of consecutive patients under 16 diagnosed with MUVL.
- Review of clinical records at least 3 months post-presentation; incidence calculated using new patient attendances.
Main Results:
- Identified 85 cases of MUVL, with an annual incidence of 3.5%.
- 33% of children had a history or signs of psychiatric disorders or experienced stressful life events.
- Recovery rate was 25%, with a median improvement of 0.22 logMAR in visual acuity.
Conclusions:
- The incidence of MUVL in children appears higher than previously reported.
- MUVL in children may be associated with underlying mental health problems.
- Screening for psychological issues is recommended to improve treatment access and outcomes for MUVL.
Abstract:
PurposeTo determine the incidence of medically unexplained visual loss (MUVL) in children in an open access children's eye casualty.Patients and methodsWe collated demographic and clinical data of consecutive patients younger than 16 years who presented to the children's eye casualty at Moorfields Eye Hospital over a 12-month period and were diagnosed with MUVL or suspected MUVL. We reviewed the clinical records at least 3 months after initial presentation. We calculated the incidence using the number of 'new patient' attendances over the same period as denominator (n=2397). We used descriptive analysis.
Main Outcome Measures:
number of patients diagnosed with MUVL, proportion of patients with a history of or present psychological problems, recovery rate, and improvement in visual acuity.ResultsWe identified 85 cases of MUVL (54 females; median age: 9 years (IQR 7-12)). The median duration of follow-up was 1.2 months (IQR 0-4.3). The estimated annual incidence was 3.5% (95% confidence interval 2.9-4.4%). Thirty-three per cent of children had a history of psychiatric disorders, reported a stressful life event, or showed signs of psychiatric disorder at the time of first presentation. The recovery rate was 25%. Median improvement in best-corrected visual acuity from presentation to last appointment was 0.22 (IQR 0.06-0.43) logMAR.ConclusionThe incidence of MUVL is higher and the rate of resolution lower than previously reported. MUVL may be associated with mental health problems. We recommend screening for psychological problems to facilitate access to psychological treatment.
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