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Visual conversion reaction is a psychosomatic anomaly that manifests as reduced visual acuity (VA) and visual field defects.1,2 Scanning laser ophthalmoscopy (SLO) can detect a scotoma and VA under direct fundus observation.3–6 However, there have been no reports of patients diagnosed with visual conversion reaction using SLO. We report a patient with visual conversion reaction using SLO.
A 20 year old woman presented with a sudden bilateral loss of vision. She reported being under severe stress at work. The best corrected visual acuity (BCVA) was counting fingers in both eyes. The external eye examination and pupillary responses were normal in both eyes. Conventional ophthalmoscopy, funduscopy, and fluorescein angiography were unremarkable. The visual fields were constricted to within 5° of fixation using Goldmann perimetry (fig 1A). The results of magnetic resonance imaging, computer tomography of the brain and orbits, visual evoked potentials, and electroretinography were unremarkable. A general medical examination showed no abnormalities. There were no scotomas (based on Goldmann size III stimulus on the retina), and the stability of fixation were central and stable using SLO microperimetry in both eyes (fig 1B). The VA using SLO was 20/200 in both eyes. We followed this patient for 10 months, and she consistently demonstrated impaired VA and visual field defects. She ultimately retired from the workforce.
Ten months later, the BCVA was 20/20 both eyes. The visual fields in both eyes using Goldmann perimetry were normal (fig 2A). There were no scotomas, and the stability of fixation was central and stable in both eyes using SLO microperimetry (fig 2B). The VA using SLO was 20/20 in both eyes. We diagnosed visual conversion reaction in this case.
This is the first report of a patient with visual conversion reaction using SLO. In this case, the BCVA was counting fingers in both eyes at the first visit. However, the VA using SLO was 20/200 both eyes and better than the conventional examination. The visual fields were constricted in both eyes to within 5° of fixation using Goldmann perimetry. However, there were no scotomas in either eye using SLO microperimetry. The distinction between the VA and visual fields between the conventional and SLO examinations was demonstrated over the 10 month follow up period. Ten months after the initial examination, the VA and visual fields were normal in both eyes by both conventional and SLO examinations. There was no distinction between them during the recovery period. Van de Velde reported that SLO results were comparable with those obtained during a conventional examination in normal subjects.3 The distinction between the VA and visual field between the conventional and SLO examinations may help in the diagnosis of patients with visual conversion reaction. Future clinical studies of several cases of visual conversion reaction using SLO are needed.