Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA.
Baylor College of Medicine, Houston, Texas, USA.
Surv Ophthalmol. 2022 Jan-Feb;67(1):8-18. doi: 10.1016/j.survophthal.2021.03.002. Epub 2021 Mar 15.
Vision loss with clinical findings that are incompatible with the symptoms and recognized neurological or ophthalmic conditions is a common presentation of patients to neurologists, ophthalmologists, and neuro-ophthalmologists. The accepted terminology to describe such patients has evolved over time, including functional visual disorder (FVD), non-organic vision loss, non-physiologic vision loss, functional vision loss, psychogenic, psychosomatic, and medically unexplained visual loss. Likewise, attitudes and recommended management options have changed over the years in the fields of psychiatry and neurology. FVD is a diagnosis of inclusion, and it is critical that the diagnosis be made and delivered efficiently and effectively to reduce patient and physician duress. We review the current Diagnostic and Statistical Manual (DSM V) terminology and the prior literature on FVD and describe how the approaches to diagnosis and management have changed. We provide recommendations on the appropriate techniques and diagnostic approach for patients with FVD. We also propose a protocol for consistent and standardized discussion with the patient of the diagnosis of FVD. We believe that the adoption of FVD as both a paradigm and nomenclature shift in ophthalmology will improve patient care.
视力丧失伴有与症状不相符且被公认的神经学或眼科疾病不相容的临床发现，是患者经常向神经科医生、眼科医生和神经眼科医生就诊的原因。描述此类患者的公认术语随着时间的推移而演变，包括功能性视觉障碍（FVD）、非器质性视力丧失、非生理性视力丧失、功能性视力丧失、心因性、心身性和医学无法解释的视力丧失。同样，精神病学和神经病学领域的态度和推荐的管理选择多年来也发生了变化。FVD 是一种包容性诊断，因此必须快速有效地做出诊断，以减轻患者和医生的压力。我们回顾了当前的《诊断和统计手册》（DSM V）术语以及关于 FVD 的先前文献，并描述了诊断和管理方法的变化。我们就 FVD 患者的适当技术和诊断方法提供了建议。我们还提出了一个用于与 FVD 患者进行一致和标准化讨论的方案。我们相信，在眼科领域采用 FVD 作为一种范例和命名法转变将改善患者护理。
