How do I manage functional visual loss.

Area of Science:

• Neuro-ophthalmology
• Functional Neurological Disorders (FND)

Background:

• Functional visual loss is a common cause of visual impairment.
• Ophthalmologists face challenges in communicating diagnoses and initiating treatment for functional visual loss.
• Limited evidence-based treatments exist despite significant long-term symptoms in adults.

Purpose of the Study:

• To outline a practical, evidence-informed approach for managing functional visual loss.
• To guide ophthalmologists in diagnosis, communication, and treatment strategies for functional visual loss.

Main Methods:

• Positive diagnosis using investigations showing normal vision despite subjective impairment.
• Clear communication emphasizing positive diagnostic findings.
• Assessment for and consideration of comorbidities (e.g., migraine, intracranial hypertension).
• Collaboration with orthoptists for diagnostic testing.
• Development of targeted treatments for photophobia.
• Inclusion of psychological factors in assessment while maintaining a broad etiological view.

Main Results:

• A structured approach to diagnosis and management of functional visual loss is presented.
• Emphasis on positive diagnostic features aids patient understanding.
• Integration of comorbidity assessment and targeted therapies can improve management.
• Future treatments like hypnotherapy and TMS show promise.

Conclusions:

• A positive diagnostic and management strategy is crucial for functional visual loss.
• Addressing comorbidities and psychological factors is important.
• Further research into novel treatment modalities is warranted for functional visual loss.