Functional vision disorder (FVD) is a relatively common diagnosis in ophthalmic practice which can be difficult to make because of clinician’s apprehension to miss organic pathology. We review the diagnostic approach to patients with FVD, organic mimics of FVD, its diagnostic and management strategies and associated cost burden. Patients with FVD typically present with visual acuity and/or field loss. Diagnostic work-up should include patient observation, detailed history, pupillary examination, dilated ophthalmoscopy, visual field testing and ganglion cell analysis of the macular complex. Most common organic mimickers of FVD are amblyopia, cortical blindness, retrobulbar optic neuritis, cone dystrophy and chiasmal tumours; however, all could be ruled out by structured diagnostic approach. For patients with unilateral visual loss, bottom-up refraction, fogging of the well-seeing eye in the phoropter, convex lens and base-down prism tests could aid in diagnosis. For patients claiming binocular vision loss, checking for eye movement during the mirror test or nystagmus elicited by an optokinetic drum can be helpful. Effective management of FVD involves reassurance, stress reduction and, if agreed on, management of comorbid anxiety and/or depression. The social cost of FVD is predominately economic as patients typically meet several healthcare providers over multiple visits and often undergo several neuroimaging studies before neuro-ophthalmology referral. Further, inappropriate granting of disability benefits confers additional stigma to patients with organic vision loss. Data are available upon reasonable request.

中文翻译：

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功能性视力障碍：诊断、管理和成本综述


功能性视力障碍 （FVD） 是眼科实践中相对常见的诊断，由于临床医生担心错过器质性病变，因此可能很难做出。我们回顾了 FVD 患者的诊断方法、FVD 的器质模拟物、其诊断和管理策略以及相关的成本负担。FVD 患者通常表现为视力和/或视野缺损。诊断性病情检查应包括患者观察、详细病史、瞳孔检查、散瞳检眼镜检查、视野检查和黄斑复合体神经节细胞分析。FVD 最常见的器质性类似物是弱视、皮质盲、球后视神经炎、视锥细胞营养不良和视交叉肿瘤;然而，所有这些都可以通过结构化诊断方法排除。对于单侧视力丧失的患者，自下而上的屈光、综合验光仪中视力良好的眼睛起雾、凸透镜和基底向下棱镜测试可能有助于诊断。对于声称双眼视力丧失的患者，在镜子测试期间检查眼球运动或视动鼓引起的眼球震颤可能会有所帮助。FVD 的有效管理包括安抚、减轻压力，以及（如果达成一致）管理共病焦虑和/或抑郁。FVD 的社会成本主要是经济成本，因为患者通常会在多次就诊时与多家医疗保健提供者会面，并且通常在神经眼科转诊之前接受多项神经影像学研究。此外，不恰当地授予残疾福利会给器质性视力丧失患者带来额外的耻辱感。数据可根据合理要求提供。