J Korean Ophthalmol Soc.  2016 Nov;57(11):1759-1764. 10.3341/jkos.2016.57.11.1759.

Analysis of Pediatric Patients Referred for Decreased Vision of Unknown Origin

• Lee SB
• Sung JY
• Lee YH

• KMID: 2357732
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1759

Abstract

PURPOSE
To identify causes of conditions presenting with low vision without distinct abnormities in pediatric patients and to determine the appropriate diagnostic approach for those conditions.
METHODS
We retrospectively reviewed medical records of pediatric patients with amblyopia, suspicious amblyopia or visual impairment of unknown origin referred by primary care providers. Patients were classified into 2 groups, amblyopia and visual impairment of unclear origin. In this study, we reviewed and analyzed the visual impairment of unclear origin.
RESULTS
Of 152 patients, 94 patients were classified as amblyopia and 58 patients were classified as visual impairment of unclear origin. Among those with visual impairment of unclear origin, 26 patients (44.8%) were classified as functional visual loss, 23 patients (39.7%) as normal corrected visual acuity, 8 patients (13.8%) as organic disease and 1 (1.7%) patient could not be classified. Fundus examination revealed abnormal findings in all patients classified as organic disease. Six patients had optic atrophy and 2 had abnormalities on the macula. Ten patients had an orbital magnetic resonance imaging (MRI) scan. Only 1 of 10 MRI scans showed causative abnormality, however, the patient showed an optic atrophy on fundus examination before the MRI scan.
CONCLUSIONS
Clinicians need to consider a high prevalence of functional visual loss and possibility of occult organic disorders when they evaluate pediatric patients presenting with decreased vision without distinct abnormities. MRI scan is recommended for only selected cases, when optic atrophy is not present.

Keyword

Amblyopia; Functional visual loss; Occult eye disease; Unexplained visual loss

MeSH Terms

Amblyopia
Humans
Magnetic Resonance Imaging
Medical Records
Optic Atrophy
Orbit
Prevalence
Primary Health Care
Retrospective Studies
Vision Disorders
Vision, Low
Visual Acuity

Reference

References

1. Amos JF. Refractive amblyopia: its classification, etiology, and epidemiology. J Am Optom Assoc. 1977; 48:489–95.

2. Amos JF. Refractive amblyopia: a differential diagnosis. J Am Optom Assoc. 1978; 49:361–6.

3. Kattouf VM, Scharre J, Tahir S, et al. Refractive error and amblyo-genic risk factors in Hispanic pre–school children. Invest Ophthalmol Vis Sci. 2005; 46:917–24.

4. Bajandas FJ, Kline LB. Neuro-Ophthalmology Review Manual. 3rd ed.New Jersey: Slack;1988. p. 163–74.

5. Shindler KS, Galetta SL, Volpe NJ. Functional visual loss. Curr Treat Options Neurol. 2004; 6:67–73.

6. Mäntyjärvi MI. The amblyopic schoolgirl syndrome. J Pediatr Ophthalmol Strabismus. 1981; 18:30–3.

7. Bose S, Kupersmith MJ. Neuro-ophthalmologic presentations of functional visual disorders. Neurol Clin. 1995; 13:321–39.

8. Kang YH, Yu YS. Functional visual loss in children. J Korean Ophthalmol Soc. 1996; 37:2118–24.

9. Wilne S, Collier J, Kennedy C, et al. Progression from first abdominal to diagnosis in childhood brain tumours. Eur J Pediatr. 2012; 171:87–93.

10. Lorenz B, Moore AT. Pediatric Ophthalmology, Neuro-Ophthalmology, Genetics. 2nd ed.Berlin: Springer;2008. p. 147–50.

11. Brodsky MC. Pediatric Neuro-Ophthalmology. 2nd ed.New York: Springer;2010. p. 236–9.