An Uncharacteristic Case Presentation of Functional Vision Disorder

Ramandeep Kaur OD, New England College of OptometryFollow
Theresa Zerilli-Zavgorodni OD, VA Connecticut Healthcare SystemFollow
Nancy Shenouda-Awad OD, VA Connecticut Healthcare SystemFollow

Medical Subject Headings

Middle Aged; Hemianopsia; Visual Fields; Stress Disorders, Post-Traumatic; Psychiatrists; Hypesthesia; Hyperlipidemias; Borderline Personality Disorder; Depression; Ophthalmologists; Ophthalmology; Vision Disorders; Blindness; Prognosis; Visual Acuity; Psychiatry; Brain Injuries; Brain Injuries, Traumatic; Anxiety Disorders; Neurology

Abstract

Background: Functional Vision Disorder (FVD), also commonly referred to as functional vision loss (FVL) or non-organic vision loss (NOVL), is defined as a visual acuity (VA) loss and/or visual field (VF) loss, without any identifiable ocular or cortical pathology. Many clinicians look at FVD as a diagnosis of exclusion and while it is imperative to rule out organic pathology, FVD diagnosis must be supported by clinical findings that prove normal visual function. Incorporating supplementary tests specific for demonstrating the integrity of the visual system and the non-organic nature of the symptoms will allow clinicians to be more confident when diagnosing FVD.

Case Report: A 59-year-old white female presented to West Haven Acquired Brain Injury (ABI) Clinic complaining of an acute isolated episode of vision loss OU lasting 30 minutes and associated with symptoms of numbness in her right upper and lower extremities. The patient had a pertinent medical history which included hypertension, hyperlipidemia, depression, borderline personality disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and multiple traumatic brain injuries (TBI). Social history revealed past substance abuse with remission for several years. Pertinent ocular history was notable for a longstanding repeatable monocular right hemianopic VF defect OD due to FVD which recently resolved spontaneously. At the present examination, a new right homonymous hemianopsia OU was confirmed with VF testing. Imaging and laboratory studies were ordered to rule out causative neurological disease and were found to be within normal limits. A thorough review of the patient’s history, clinical examination findings, ancillary testing results, as well as a comprehensive interdisciplinary management with neurology, neuro-ophthalmology, and psychiatry lead to the diagnosis of a reoccurrence of FVD.

Conclusion: It is crucial not to dismiss a new neurological finding in the setting of a previously diagnosed FVD. Concurrent organic disease with FVD is common and thus warrants considerable caution on the part of the eye care provider. Distinguishing between organic and nonorganic visual complaints has important clinical implications for the patient. FVD commonly occurs in situations of psychological conflict. Timely diagnosis and appropriate referrals to manage this conflict will improve prognosis and prevent unnecessary work ups as well as help alleviate the patient’s anxiety. Co-management with a psychiatrist and neuro-ophthalmologist is often essential for diagnosis and management. This case review demonstrates an atypical presentation of FVD in which complete resolution of the VF loss was followed by an acute re-occurrence of FVD but manifesting with a different VF pattern. Emphasis will be placed on the history, clinical observation, and testing techniques utilized to aid in diagnosis of FVD as well as highlight the appropriate referral and management.

Recommended Citation

Kaur R, Zerilli-Zavgorodni T, Shenouda-Awad N. An Uncharacteristic Case Presentation of Functional Vision Disorder. Optometric Clinical Practice. 2025; 7(1):27. https://doi.org/10.37685/uiwlibraries.2575-7717.7.1.1036