There is an increasing number of people complaining of vision impairment in the absence of objective organic alterations. According to a study by the San Giuseppe Hospital in Milan, the problem has worsened after the pandemic
The Covid pandemic has led to widespread psychological distress, which can manifest itself – and this is new – also as a visual impairment. In a soon-to-be-published study, experts fromSan Giuseppe Hospital – MultiMedica in Milan — on the occasion of World Sight Day, which is celebrated on October 12 — highlight how patients with «functional visual loss» or «functional blindness» (more or less serious visual impairment characterized by the absence of organic alterations detected in the eye exam) have more than doubled in the post-pandemic period. The authors of the work compared the patients treated in the ophthalmology clinics of the San Giuseppe Hospital before the pandemic (from January to June 2019) with those followed from January to June 2023. Out of a total of approximately 3,600 subjects visited in both periods, there were 144 cases of functional visual loss in the pre-pandemic period compared to 326 in the post-pandemic period, with a doubling of the incidence (from 4 to 9%). In both the first and second periods, more than 80% of diagnoses concerned minors.
Physical symptoms
«If we exclude those subjects who intentionally fake the symptom – such as children who, to emulate their brother or classmate, would like to wear glasses even if they don’t need them – and who the doctor easily “unmasks”, there remains a significant portion of patients affected by a conversion disorder – explains Andrea Lembo, ophthalmologist at San Giuseppe Hospital and author of the study —. It is a form of somatization in which a psychological discomfort is involuntarily projected by the subject into a physical symptom, a bit like those children who get a stomach ache because they are anxious about the test at school. In our case the discomfort manifests itself in the form of visual difficulty, for example in seeing the blackboard, fogging, burning eyes, headache, reduction of the visual field and other vision-related disorders. We believe that the increase in these cases, found in recent months, may be in some way related to the Covid pandemic due to the profound psychosocial changes that the latter has brought with it”.
How to reach the diagnosis
The management of functional blindness requires first of all an accurate medical history on the part of the specialist, who must be careful in understanding it any incompatibility between the symptoms and daily life reported by the patient (for example, he says he cannot see but plays tennis) and must try to arrive at the diagnosis without an excessive number of instrumental tests, aimed at excluding other pathologies. «In the case of minors – highlights Lembo -, dialogue with the parent is fundamental to arrive at the diagnosis and trace the problem that may be at the basis of the conversion disorder. Many have told us that the confinement due to the pandemic has affected the psychology of their children, limiting their ability to interact and socialize with their peers.”
Possible strategies
Secondly, the therapeutic response to be given to patients must be carefully evaluated, which must be based above all on reassurance. «Reassuring does not mean underestimating or belittling what patients report – specifies Lembo -, but helping them identify effective strategies to alleviate symptoms. I mean even very simple suggestions, like look out the window for 30 seconds so as not to overload the accommodation of the eye in a video terminal or close your eyes for 5 seconds to let them rest and understand if the images on the blackboard become clear again, in a school-age child. It can also be exploited the placebo effect. In patients who continued to report a certain symptom, especially children, before proceeding with an MRI we tried to give glasses with neutral lenses. In several cases the strategy worked, evidently because the child felt in some way “protected”. In other cases, further investigations are needed, such as in front of persistent headachesfor which one second opinion in Neurology is undoubtedly an appropriate choice.”
The incidence will grow
«Although ours is an extremely specialized discipline, it cannot fail to reflect the profound changes in society – he adds Paolo Nucci, senior consultant of the University Eye Clinic San Giuseppe and full professor of Ophthalmology at the University of Milan -. In addition to the drama we have experienced, the pandemic has produced a series of direct consequences on the psychology of all of us. AND these emotional aftermaths are also producing effects on visual perception. Furthermore, for some time now we have been witnessing the emergence of models who, through social media, impose messages of surreal perfection in every area of life. Young people risk feeling forced to conform to social expectations in order to be accepted by others, with inevitable repercussions on their mental health. Faced with this scenario, we can hypothesize that the incidence of functional blindness will continue to grow in the coming years».
The case of Lombardy
Many of the patients who attend the San Giuseppe Hospital in Milan come from Lombardy, Region first hit by the epidemic wave, where fears due to the spread of the infection and the limitations imposed on movement persisted and had the opportunity to impact the population for longer. One of the possible future developments of the study could, therefore, be an extension of the survey to other ophthalmological centersto evaluate any differences in the incidence of cases of functional visual loss in regions affected differently by the pandemic.
October 11, 2023 (modified October 11, 2023 | 3:17 pm)
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