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Lee, Sung, and Lee: Analysis of Pediatric Patients Referred for Decreased Vision of Unknown Origin
Original Article

J Korean Ophthalmol Soc 2016;57(11):1759-1764.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1759

Analysis of Pediatric Patients Referred for Decreased Vision of Unknown Origin

Sung Bok Lee, MD, PhD, Jae Yun Sung, MD, Yeon Hee Lee, MD, PhD

Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea

Address reprint requests to Yeon Hee Lee, MD, PhD Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: 82-42-280-8447, Fax: 82-42-255-3745 E-mail: yeonheelee72@gmail.com

Received 23 June 2016       Revised 18 August 2016       Accepted 20 October 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To identify causes of conditions presenting with low vision without distinct abnormities in pediatric patients and to determine the appropriate diagnostic approach for those conditions.

Methods

We retrospectively reviewed medical records of pediatric patients with amblyopia, suspicious amblyopia or visual impairment of unknown origin referred by primary care providers. Patients were classified into 2 groups, amblyopia and visual impairment of unclear origin. In this study, we reviewed and analyzed the visual impairment of unclear origin.

Results

Of 152 patients, 94 patients were classified as amblyopia and 58 patients were classified as visual impairment of unclear origin. Among those with visual impairment of unclear origin, 26 patients (44.8%) were classified as functional visual loss, 23 patients (39.7%) as normal corrected visual acuity, 8 patients (13.8%) as organic disease and 1 (1.7%) patient could not be classified. Fundus examination revealed abnormal findings in all patients classified as organic disease. Six patients had optic atrophy and 2 had abnormalities on the macula. Ten patients had an orbital magnetic resonance imaging (MRI) scan. Only 1 of 10 MRI scans showed causative abnormality, however, the patient showed an optic atrophy on fundus examination before the MRI scan.

Conclusions

Clinicians need to consider a high prevalence of functional visual loss and possibility of occult organic disorders when they evaluate pediatric patients presenting with decreased vision without distinct abnormities. MRI scan is recommended for only selected cases, when optic atrophy is not present.

Keywords: Amblyopia, Functional visual loss, Occult eye disease, Unexplained visual loss

References

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Table 1.
Final diagnosis and demographics of the subjects
Group FVL Normal BCVA Organic disease Unclassified Total
Number of patients (%) 26 (44.8) 23 (39.7) 8 (13.8) 1 (1.7) 58 (100)
Age (years) 8.9 ± 1.6 7.9 ± 1.7 7.9 ± 2.7 6.0 ± 0.0 8.3 ± 1.9
Gender (male:female) 11:15 13:10 5:3 1:0 28:30
Initial BCVA of worse eye (log MAR) 0.44 ± 0.30 0.04 ± 0.07 0.47 ± 0.30 0.2 ± 0.0 0.26 ± 0.31
  (0.1–1.2) (−0.1–0.15) (0.2–1.0) (0.2–0.2) (−0.1–2.0)
Follow up period (months) 4.7 ± 7.5 10.0 ± 15.4 22.6 ± 30.1 2.0 ± 0.0 9.4 ± 16.3
  (0–28) (0–53) (0–80) (2) (0–80)

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated. FVL = functional visual loss; BCVA = best corrected visual acuity.

Table 2.
List of patients with organic disease
Patients s Age (years) Gender Final diagnosis Fundus finding OCT finding
1 11 Male X-linked Juvenile retinoschisis Spoke wheel-like striations radiating from fovea Foveal cystic retinoschisis
2 7 Female LHON Temporal pallor of optic disc Decreased RNFL average thickness at temporal aspect
3 5 Male ADON Focal, wedged-shaped temporal optic pallor, Papillomacular bundle thinning Decreased average RNFL thickness at temporal aspect
4 8 Male ADON Focal, wedged-shaped temporal pallor of optic disc, Superotemporal papillomacular bundle thinning Decreased average RNFL thickness at superotemporal aspect
5 11 Male ADON Focal, wedged-shaped temporal pallor of optic disc, Papillomacular bundle thinning Decreased RNFL average thickness at temporal aspect
6 4 Female Optic nerve glioma Generalized optic disc pallor, Generalized thinning of RNFL Decreased average RNFL thickness at all quadrant
7 11 Male ADON Focal, wedged-shaped temporal pallor of optic disc, Papillomacular bundle thinning Decreased average RNFL thickness at temporal aspect
8 6 Female Progressive cone dystrophy Bull's eye maculopathy Disruption of the photoreceptor inner segment– outer segment junction

OCT = optical coherence tomography; LHON = Leber's hereditary optic neuropathy; ADON = autosomal dominant optic neuropathy; RNFL = retinal nerve fiber layer.

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