eye health

Medically unexplained visual loss in a specialist clinic: a retrospective case-control comparison

Conversion disorder,Functional vision loss,Medically unexplained vision loss,Neuro-ophthalmology,Psychological,Visual reduction
J Neurol Sci. 2016 Feb 15;361:272-6. doi: 10.1016/j.jns.2015.12.045. Epub 2015 Dec 29.

Medically unexplained visual loss in a specialist clinic: a retrospective case-control comparison.

Abstract

PURPOSE:

To compare the clinical and demographic characteristics of adult patients with nonorganic or medically unexplained visual loss (MUVL) to those with other common conditions presenting to a neuro-ophthalmology clinic.

METHODS:

Case-control design: a retrospective review of medical notes on a consecutive case series of 49 patients assessed at the King’s College Hospital neuro-ophthalmology clinic with unexplained visual loss and matched with the next assessed patient identified from clinic records. Patients presented post-symptom onset with a mean clinical course of 30months (SD=67months) and standard clinical examination used to confirm diagnoses, alongside ancillary investigations if required.

RESULTS:

Seventy-two percent (n=36) of MUVL patients were female. In comparison with patients with organic visual disorders, MUVL cases presented with significantly higher rates of bilateral (cf. unilateral) visual impairment (41%, n=20), premorbid psychiatric (27%, n=13) as well as functional (24%, n=12) diagnoses and psychotropic medication usage (22%, n=11). Medically unexplained cases were significantly more likely to report preceding psychological stress (n=9; 18%).

CONCLUSIONS:

Medically unexplained visual impairment may be regarded as part of the spectrum of medically unexplained disorders seen in the general hospital setting. Research is needed to determine long-term outcomes and effective tailored interventions.

Copyright © 2016 Elsevier B.V. All rights reserved.

KEYWORDS:

Conversion disorder; Functional vision loss; Medically unexplained vision loss; Neuro-ophthalmology; Psychological; Visual reduction

CONCLUSIONS:

Medically unexplained visual impairment may be regarded as part of the spectrum of medically unexplained disorders seen in the general hospital setting. Research is needed to determine long-term outcomes and effective tailored interventions.

Copyright © 2016 Elsevier B.V. All rights reserved.

KEYWORDS:

Conversion disorder; Functional vision loss; Medically unexplained vision loss; Neuro-ophthalmology; Psychological; Visual reduction