J Korean Ophthalmol Soc.  2016 Sep;57(9):1435-1440. 10.3341/jkos.2016.57.9.1435.

The Clinical Features and the Prognosis of Functional Visual Loss in Children

Affiliations
  • 1Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea. opticalyh@hanmail.net
  • 2Research Institute for Medical Sciences, Chungnam National University, Daejeon, Korea.

Abstract

PURPOSE
To evaluate the clinical characteristics and prognoses of children with functional visual loss.
METHODS
Retrospective medical record review was performed in 53 patients 4 to 16 years of age diagnosed with functional visual loss between April 2006 and February 2014. We investigated the clinical features and results of clinical tests and the final status of the patients.
RESULTS
Twenty male (37.8%) and 33 female (62.2%) patients were included in the study. The mean age was 9.69 ± 2.76 years. The incidence was highest between 8 to 12 years. The mean best corrected visual acuity at baseline was 0.43 ± 0.23, and 88.7% of patients had mild to moderate visual loss. The symptoms were bilateral in 96.2% of patients, and the difference of corrected visual acuity between two eyes was 1 line or less on Snellen chart in 94.1% of bilateral cases. The symptoms were resolved by 1.8 ± 1.0 months in 59.5% of patients and resolved by the final follow-up visit in 51 (96.2%). However, the symptoms persisted through the final follow-up in 2 patients.
CONCLUSIONS
Most children with functional visual loss have bilateral and mild to moderate visual loss. The prognosis of functional visual loss in children was excellent. Most patients recovered from the disease with reassurance supportive care without psychiatric treatment, although a few patients had persistent symptoms.

Keyword

Functional visual loss; Non-organic visual loss; Psychogenic visual loss

MeSH Terms

Child*
Female
Follow-Up Studies
Humans
Incidence
Male
Medical Records
Prognosis*
Retrospective Studies
Visual Acuity

Figure

  • Figure 1. The distribution of age and sex of the subjects. Female was more common and patients between 8 and 12 years old were most common.

  • Figure 2. The distribution of visual loss in the subjects. Most subject showed mild or moderate visual loss. Mild: best-cor-rected visual acuity (BCVA) ≥ 0.5; Moderate: 0.2 ≤ BCVA < 0.5; Severe: BCVA < 0.2.

  • Figure 3. Difference of line on snellen visual acuity chart between both eyes in bilateral cases. Most of bilateral cases showed the difference of visual acuity less than 1 line between both eyes.

  • Figure 4. Flow chart of the diagnosis and course. Number of eligible patients was 53. Normal visual acuities were proved in 47 patients on initial visit. Forty five of them recovered from their symptom and sign spontaneously. But two patients had persistent symptom. Normal visual acuities were not proved in 6 patients on initial visit. All of them recovered from their symptom and sign spontaneously.


Reference

References

1. Kathol RG, Cox TA, Corbett JJ, Thompson HS. Functional visual loss. Follow-up of 42 cases. Arch Ophthalmol. 1983; 101:729–35.
2. Miller NR, Newman NJ, Biousse V, Kerrison JB. Walsh and Hoyt's Clinical Neuro-Ophthalmology. 6th ed.1. Baltimore: Williams & Wilkins;2005. p. 1315–34.
3. Ney JJ, Volpe NJ, Liu GT, et al. Functional visual loss in idiopathic intracranial hypertension. Ophthalmology. 2009; 116:1808–13.e1.
Article
4. Egan RA. Functional visual loss. Ophthalmol Clin North Am. 2004; 17:321–8. vi.
Article
5. Bose S, Kupersmith MJ. Neuro-ophthalmologic presentations of functional visual disorders. Neurol Clin. 1995; 13:321–39.
Article
6. Catalano RA, Simon JW, Krohel GB, Rosenberg PN. Functional visual loss in children. Ophthalmology. 1986; 93:385–90.
Article
7. Taich A, Crowe S, Kosmorsky GS, Traboulsi EI. Prevalence of psychosocial disturbances in children with nonorganic visual loss. J AAPOS. 2004; 8:457–61.
Article
8. Clarke WN, Noël LP, Bariciak M. Functional visual loss in children: a common problem with an easy solution. Can J Ophthalmol. 1996; 31:311–3.
9. Mäntyjärvi MI. The amblyopic schoolgirl syndrome. J Pediatr Ophthalmol Strabismus. 1981; 18:30–3.
Article
10. van Balen AT, Slijper FE. Psychogenic amblyopia in children. J Pediatr Ophthalmol Strabismus. 1978; 15:164–7.
Article
11. Toldo I, Pinello L, Suppiej A, et al. Nonorganic (psychogenic) abdominal loss in children: a retrospective series. J Neuroophthalmol. 2010; 30:26–30.
12. Lee SM, Lim MH, Kyung SE. Child behavior check list, Korean personality inventory for children in presumed functional visual loss. J Korean Ophthalmol Soc. 2010; 51:1092–8.
Article
13. Kang YH, Yu YS. Functional visual loss in children. J Korean Ophthalmol Soc. 1996; 37:2118–24.
14. Kim JS, Hwang JM. Clinical Neuro-Ophthalmology. 1st ed.Seoul: E-public;2010. p. 288–303.
15. Miller BW. A review of practical tests for ocular malingering and hysteria. Surv Ophthalmol. 1974; 17:241–6.
16. Sletteberg O, Bertelsen T, Høvding G. The prognosis of patients with hysterical visual impairment. Acta Ophthalmol (Copenh). 1989; 67:159–63.
Article
17. Hafeiz HB. Hysterical conversion: a prognostic study. Br J Psychiatry. 1980; 136:548–51.
Article
18. Yasuna ER. Hysterical amblyopia in children. Am J Dis Child. 1963; 106:558–63.
Article
19. Krill AE, Newell FW. The diagnosis of ocular conversion reaction involving visual function. Arch Ophthalmol. 1968; 79:254–61.
Article
20. Rada RT, Meyer GG, Krill AE. Visual conversion reaction in children. I. Diagnosis. Psychosomatics. 1969; 10:23–8.
Article
21. Bain KE, Beatty S, Lloyd C. Non-organic visual loss in children. Eye (Lond). 2000; 14(Pt 5):770–2.
Article
22. Barris MC, Kaufman DI, Barberio D. Visual impairment in hysteria. Doc Ophthalmol. 1992; 82:369–82.
Article
23. Kramer KK, La Piana FG, Appleton B. Ocular malingering and hysteria: diagnosis and management. Surv Ophthalmol. 1979; 24:89–96.
Article
24. Keltner JL, May WN, Johnson CA, Post RB. The California syndrome. Functional visual complaints with potential economic impact. Ophthalmology. 1985; 92:427–35.
25. Lim SA, Siatkowski RM, Farris BK. Functional visual loss in adults and children patient characteristics, management, and outcomes. Ophthalmology. 2005; 112:1821–8.
Full Text Links
  • JKOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr