Characteristics of 110 Patients With Functional Visual Loss

Abstract

Functional visual loss (FVL) is characterized by complaints of visual impairment without evidence of an organic cause. Physicians are often reluctant to diagnose FVL, thus little is known about the healthcare utilization in patients with FVL. Retrospective case series METHODS: 110 patients that were seen at two university-affiliated neuro-ophthalmology practices who were diagnosed with FVL were included. Medical records were evaluated, and data were collected on demographics, clinical presentation, ophthalmologic examination, neuroimaging, ancillary tests, and other healthcare provider visits and treatments. Over 70% of patients with FVL were women with a mean age of 37 ± 15 years. The presenting complaint in 71.8% (79/110) of participants was decreased vision which was bilateral in over 50% of cases. Close to half (53/110) endorsed at least one co-existing psychiatric or neurologic diagnosis. The mean number of different medical specialists seen before neuro-ophthalmic consultation was 3.7 ± 2.6, and the average number of healthcare visits was 4.6 ± 4.4. Each patient had 2.2 ± 1.8 neuroimaging studies performed. Fifteen percent of patients underwent unnecessary treatments, including receiving steroids, visual therapy, and prisms. Patients with FVL typically see at least three different healthcare providers across four different visits and undergo at least 2 neuro-imaging studies before having neuro-ophthalmic consultation. To avoid this undue burden on patients and the healthcare system, clinicians should refer patients with suspected FVL to a neuro-ophthalmologist to confirm the diagnosis of FVL and appropriately counsel the patient.