Non-organic visual loss in children: prospective and retrospective analysis of associated psychosocial problems and stress factors

Abstract

Purpose: To report on the prevalence of non-organic visual loss (NOVL) and its associated psychopathology and psychosocial stress factors on children presenting with visual problems without an obvious cause at a routine ophthalmological examination.

Methods: One hundred and seventy children presented at our paediatric ophthalmology department between 2007 and 2014 with visual loss. Routine examination showed no obvious underlying cause. Pattern-onset visual-evoked potentials (pVEPs) were performed to obtain an objective visual assessment. Selected patients underwent more investigations, and follow-up was organized in every child to differentiate organic visual loss (OVL) from NOVL. In the NOVL group, we retrospectively analysed the medical file data and prospectively the questionnaires completed by patients and their parents.

Results: Eighty-five children (50%) were diagnosed with OVL, the other 50% of children were diagnosed with NOVL. In the latter, girls predominated and the mean age was 11.0 years. The most common presenting symptom was binocular reduced visual acuity. pVEPs were normal in all patients. We categorized associated comorbidity in the NOVL group in three subgroups: malingering, psychosocial stressors and child psychiatric disorders.

Conclusion: Non-organic visual loss in children is a common diagnosis in clinical practice. The diagnosis is made by recognition of characteristic features and by exclusion of organic disease. pVEP is a useful tool to obtain an objective visual acuity and to differentiate functional from organic vision loss. The prognosis in NOVL is good with a spontaneous recovery in the majority of patients. Ophthalmologists should be aware of possible underlying psychosocial and psychiatric disorders; referral can be necessary.

Keywords: children; functional visual loss; non-organic visual loss; psychiatric; psychopathology; psychosocial; visual-evoked potential.