Nonorganic Vision Loss

very neurologist, ophthalmologist or neuro-ophthalmologist will encounter patients with nonorganic vision loss at some point in their practice. The challenging issue is how to demonstrate normal visual function with objective evidence, while making sure not to miss organic causes of vision loss. The evaluation of such patients could be time consuming and frustrating, both for the patient and the examiner. There are multiple tests that help to concur normal visual functions in such patients. It is important determine baseline visual acuity, and to evaluate the pupils, anterior segment and the fundus, while estimating degree of visual field loss or the absence of field loss. Supplementary tests, like automated perimetry, optical coherence tomography, electroretinogram and visual evoked potentials, may be used in the assessment of these patients. Once the diagnosis is established, revealing the diagnosis to the patient and the family can be tricky and can often cause mistrust and frustration, and can pave pathways for medicolegal issues if not handled adeptly. Often, unknown to the physician, there may be hidden psychological conflicts and history of abuse that could be an underlying factor. Hence, no matter how frustrating it is to the physician, a gentle approach is always beneficial. In this article, we will discuss a few clinical and diagnostic methods of evaluating patients with nonorganic vision loss.