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Functional vision disorder: a review of diagnosis, management and costs
  1. Brendan Ka-Lok Tao1,
  2. Jim Shenchu Xie2,
  3. Edward Margolin3
  1. 1Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Ophthalmology & Vision Science, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Edward Margolin, Ophthalmology, University of Toronto, Toronto, ON M5N 1E3, Canada; edmargolin{at}


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.

  • Field of vision
  • Treatment Medical
  • Vision
  • Visual pathway

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  • BK-LT and JSX are joint first authors.

  • Twitter @brendantao

  • BK-LT and JSX contributed equally.

  • Contributors BT and JSX contributed to literature search, interpretation of findings, synthesis and writing. EM contributed to synthesis, supervision, clinical expertise and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.