Page 190 - A Magyar Szemorvostársaság 2023. évi kongresszusa - Tudományos program és előadáskivonatok

Experience of functional vision loss in catching-up municipalities
Katalin Varga , Patrícia Domsa
1
2
1 Magyar Máltai Szeretetszolgálat Egészségügyi Kft., Budapest
2 Non Plus Ultra Látásközpont, Budapest

Literature review - explanation of terms: The phenomenon, nowadays known as functional
vision loss (FVL), has been described for more than 40 years. In 1981 it was called "The
Amblyopic Schoolgirl Syndrome" in Finland. Later it was usually referred to as "non-organic
vision loss" in the literature. Today, FVL is the most common name. An article published in
2022 refers to FVL as a true loss of vision caused by certain diseases, so it is important to
emphasise that in my presentation I am talking about functional vision loss caused by
psychosocial factors.

Experiential journey: Although we are familiar with the phenomenon, we did not expect to
encounter it almost every day in the population we examine. Thus, the differentiation of FVL
in our work is of great importance and is now a matter of experience.

Methods: Studies report several monocular and binocular tests for differentiating FVL. In our
work, we encounter the binocular FVL more often and have gained experience in testing it.
The tests are very simple to perform and require only the simplest equipments. Solely by
encouraging and praising the child can be enough to achieve a visual acuity of 1.0. In many
cases, the same result can be achieved by placing a plan or +0.12 sph lens in the test frame
or simply by placing the test frame without a lens.

Case study: Bruce and Newman identify three major categories of functional disorders:
somatoform disorders (also commonoly referred to as ’hysteria’), factitious disorders, and
malingering.

The cases we present belong to the somatoform group. We present a more general and a
more complex case of FVL. The general case is when the pre-screening tells us that they do
not see the largest sign. After a few words of encouragement at the vision screening, we put
on the test frame without lens or with a plan lens and they read 1.0.

In the more complicated case, we were unable to prove a visual acuity of 1.0 during the first
vision test. Further paediatric ophthalmological and neurological examinations proved that
there was no underlying abnormality. In the second vision test, using FVL differentiating
methods, we proved a visual acuity of 1.0.

Summary: In catching-up municipalities, the phenomenon of FVL is encountered on a daily
basis, caused by psychosocial factors resulting from the disadvantaged situation of children.
Its type is most often somatoform, but many times it is malingering, which in their case is due
to the desire to wear glasses. We feel it is our duty to report these cases to the local "Presence
Point" staff, although they are often already aware of the child's psychosocial disorders.