Functional visual loss.

PURPOSE OF REVIEW: Functional visual loss (FVL) is a syndrome in which subjective visual parameters are inconsistent with objective measures. Recent advances in understanding the pathophysiology and management of functional disorders and FVL will be explored.

RECENT FINDINGS: FVL requires a positive diagnosis of normal function through clinical examination or visual electrophysiology. A substantial proportion of patients have an underlying organic illness that needs to be identified and treated. Recent updates in Diagnostic and Statistical Manual of Mental Disorders-5 reflect the observation that many patients with FVL do not have a recognizable psychological association. A small number of functional neuroimaging studies suggest that there may be a stress-mediated prefrontal suppression of visual awareness. There is limited evidence to guide the treatment of FVL; education and reassurance remain first line, followed by cognitive behavioral therapy and pharmacotherapy for psychiatric comorbidities.

SUMMARY: FVL remains a poorly studied and understood condition. Recent advances in the understanding and management of functional symptoms more generally may aid in advancing the understanding of this condition.