Curative effect of vision therapy on children with functional visual loss / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the curative effect of vision therapy on children with functional visual loss.<p>METHODS: Totally 22 children with functional vision loss were enrolled in our department between January 2018 and June 2018, including 12 males and 10 females, the mean age 7.5±0.8 years old. All patients had routine eye examinations, refraction and binocular visual function examinations. Children with or without astigmatism whose diopter spherical mirror was between±1.00D and were accompanied by astigmatism less than ±1.00D participated in personalized vision therapy. Paired <i>t</i> test was used to analyze the binocular visual function before and after vision therapy.<p>RESULTS: The average visual acuity of the 22 children were improved, but the diopters before and after vision therapy were -0.011±0.573D and -0.057 ±0.338D drespectively, without statistical significance(<i>P</i>=0.633). The average of the distant level phoria(DLP)before and after vision therapy were -3△ ±2.97△ and -1.18△ ±1.6△, which was not statistically significant(<i>P</i>=0.089). The near level phoria(NLP)were -6.27△ ±4.56△ and -2.82△ ±2.56△; the near point of convergene(NPC)were 7.73±2.15 and 3.05±0.69cm; the accommodation convergence/accommodation(AC/A)were 2.00±1.55, 3.64±0.5 before and after the training respectively(<i>P</i><0.05); The negative relative accommodation(NRA)and positive relative accommodation(PRA)before vision therapy were 1.61±0.41 and -1.98±0.71D; after training they were 2.09±0.23 and -3.89±0.71D respectively; binocular crossed-cylinder(BCC)was 0.09±0.38D, which improved to 0.39±0.13D after therapy; the average of amplitude of accommodation(AMP)were 9.55±2.54 and 11.55±1.13D; binocular accommodation facility(BAF)were 3.36±2.73 and 9.64±1.5cpm respectively before and after therapy.<p>CONCLUSION:It is necessary to perform binocular visual function examination base on the refractive examination for children with functional vision loss. Visual therapy can improve visual acuity and binocular vision function.

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

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.

Analysis of Pediatric Patients Referred for Decreased Vision of Unknown Origin

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.

Four cases report of functional visual loss / 上海交通大学学报（医学版）

Functional visual loss is caused by the functional disturbance of visual cortical area, which is induced by strong emotion impact. With the characteristics of diverse clinic symptoms, functional visual loss is usually hard to be identified and diagnosed. Four cases of functional visual loss are reported in this article. The patients were diagnosed by the query of medical history, observation of behavior and some examinations such as foggy test. The patients received suggestibility treatment, and achieved favourable therapeutic effect.

Child Behavior Check List, Korean Personality Inventory for Children in Presumed Functional Visual Loss

PURPOSE: To investigate the clinical courses of children with functional visual loss and to evaluate their psychosocial problems. METHODS: Thirteen children who visited the ophthalmic clinic of Dankook University Hospital because of functional vision loss between August 1, 2005 and January 1, 2009 were examined to establish the cause of lost vision. The results of the child behavior checklist-Korean version (K-CBCL) and the Korean personality inventory for children (KPI-C) were obtained in nine out of the 13 children. RESULTS: The mean visual acuities at the initial and last visits for nine children in the functional visual loss group were 0.58 +/- 0.28 and 0.89 +/- 0.31, respectively. Somatic complaints, social problems and overall behavioral problems were statistically significantly different from those of the control group according to the K-CBCL, and somatic concern was statistically significantly different from that of the control group according to the KPI-C. CONCLUSIONS: Children in the functional visual loss group had different traits from those in the control group according to the K-CBCL and KPI-C. Children's psychosocial problems could be expressed as somatic symptoms, of which vision loss should be considered a major factor.

Clinical Features of Ocular Disabilities

PURPOSE: To describe the characteristics of the disabled patients visiting the eye clinic in our institute. METHODS: We carried out a retrospective analysis of 35 cases in our clinic from April 2004 to June 2008 using the McBride disability evaluation. We investigated the clinical features and the causes of disorders through visual acuity, visual field and ocular motility. RESULTS: Thirty-three (94.3%) of the 35 patients had disabilities due to trauma; twelve (34.3%) of them were caused by traffic accidents, and 21 (60%) of them were due to blows or lacerations. Other causes of disability were glaucoma and retinal break (5.8%). Nine patients (25.7%) had abnormal findings in the visual field examination, and nine other patients (25.7%) had limitations in ocular motility. Twenty-eight patients (80%) had decreased visual acuity, and nine (25.7%) had multiple symptoms. CONCLUSIONS: Considering the contribution of disability estimation of visual field and ocular motility in McBride disability evaluations, we considered the importance of repetitive examinations and evaluations. When patients complained of unexplained decreased visual acuity with no anatomical abnormalities, multifocal ERG and multifocal VEP should be considered in order to distinguish it from malingering or functional visual loss.

The Effectiveness of Visual Evoked Potentials in Disability Evaluation

PURPOSE: This study aimed to find out whether the pattern and flash visual evoked potentials (VEP) is useful as methods to examine functional visual loss (FVL) among patients complaining of decreased visual acuity after trauma. METHODS: The medical records of trauma-related patients entrusted to the department of ophthalmology for evaluation from January 2001 to October 2004 were reviewed, Correlation were then analyzed by comparing visual acuity, visual field, and visual evoked potentials. RESULTS: There were 45 subjects, 23 of whom complained of symptoms including decreased visual acuity or visual field constriction in one eye. However no abnormalities were found in ophthalmologic tests, and pattern of flash visual evoked potentials were found to be normal for their eyes. Therefore, the cases were diagnosed with functional visual loss. Among the 23 cases, 4 showed abnormal results in the pattern visual evoked potentials, but findings for the eyes in terms of flash visual evoked potentials were normal, so these were also diagnosed with functional visual loss. CONCLUSIONS: With visual evoked potentials only, one cannot diagnosed functional visual loss, but, it could be employed usefully as complementary test in the examination of patients for whom functional visual loss is doubted clinically.

An Analysis of Visual Fields in Patients with Post-traumatic Functional Visual Loss

PURPOSE: Recently, patients complaining visual disability following an accident is increasing. Using detailed ophthalmological test, the authors estimated the incidence of the functional visual loss(FVL) and its characteristics. METHODS: Sixty nine patients were evaluated because of visual complaints after traffic accidents. Goldmann perimetry, Humphrey field analyzer, tangent screen, or confrontation test was used to test visual field. FVL was diagnosed when patients in patients complained but visual field loss which was inconsistent with clinical symptom and sign. RESULTS: Thirty-eight patients(55%) were identified to have functional visual loss. Higher incidence was documented in women (16 of 20, 80%) than in men (22 of 49, 45%). All of them showed the visual fields findings which were compatible with FVL including visual field constriction, spiral field, "clover-leaf" pattern or tubular field. CONCLUSIONS: Although the visual field examination is no more than a subjective test, it is one of the most useful method for disclosing FVL. To correlate the patient's symptoms and visual field findings, detailed ophthalmic examination and patient's socio-economic backgrounds should be taken into account.

Differential Diagnosis of Optic Neuropathy

PURPOSE: In order to prospectively investigate the causative mechanisms of visual loss in 42 patients referred to rule out optic neuropathy or diagnosed with optic neuropathy in other hospitals. METHODS: Thorough history taking and ophthalmologic examinations were performed. In some patients, evaluation of extraocular movement, nerve fiber layer photography, contrast sensitivity, visual evoked potential, electroretinogram and visual field were tested. RESULTS: Functional visual loss was most common(18 patients), followed by retinopathy(nine patients). Three patients suffered from amblyopia and glaucoma, respectively, two from keratoconus, pseudopapilledema, miscorrected refractive error, and Leber's congenital amaurosis, respectively, and one from cortical visual impairment. In the differential diagnosis of optic neuropathy, history taking and ophthalmologic examinations including pupillary light reflex, color vision test, nerve fiber layer photography, funduscopy and visual field test were useful. Especially the color vision test was very simple, but useful. CONCLUSION: Clinical entities including functional visual loss and retinopathy should be considered when diagnosing visual loss of unknown etiology.