Functional Vision Loss Flashcards
what are the TWO main categories of functional vision loss;
Malilngering
Hysteria
How can you Distinguish malingering?
hints of personal gain
avoidance of something unpleasant
How can you Distinguish Hysteria?
history of psychosocial stress
typical demographic profile
la belle indifference (emotional response is much too mild for the degree of vision loss)
typical demographic profile for Hysteria
Female > male
Pre-adolescent females
monocular or binocular both moderate and severei.e., all cases.
Comprehensive evaluation of the tissues of the eye
pupillary light reaction
Potential Acuity Meter (PAM)
confrontation test
monocular or binocular moderate degree of vision loss
Quickly altering test distance to see if acuity remains consistent
Prolonged or delayed refraction with encouragement
monocular or binocular severe degree of vision loss
Optokinetic nystagmus (OKN) Behaviors that are intact for the blind Behaviors that are absent in the blind
monocular moderate or severe
The paired cylinder test
Interruption of vision with a strong plus lens
Prism dissociation
monocular moderate vision loss
American Optical Malingering Test
(or Vectographic slide)
reading bar test
suspected malingering
confrontation test paired cylinder test interruption of vision with strong plus prism dissociation AO Malingering Test behaviors intact or lost in the blind
suspected hysteria
potential acuity meter
prolonged or delayed refraction
tangent screen
either malingering or hysteria
comprehensive evaluation of the tissues of the eye pupils behaviors intact or absent in the blind quickly altering reading distance OKN reading bar
Pathologisies that are easily confused with FVL
optic nerve disease early keratoconus mild amblyopia early Stargardt’s disease (no sign) central serous chorioretinopathy
Distinguishing FVL from ON disease
look for APD. Do it over and over again. move the flashlight quickly. look for asymmetry.
general management strategies for malingerers
don’t confronts them.. Say “I could not find the cause of your vision loss, we need you to come back , have the drops, we are not done testing you”
