Non-organic vision loss (NOVL) is defined as a decrease in visual acuity or visual field without an identifiable organic cause. NOVL can be particularly challenging and time-consuming to diagnose, especially where the vision loss is superimposed on an element of true organic pathology. The authors present a case series of six cases of NOVL in patients who sustained ocular or non-ocular injuries while serving in combat operations in Afghanistan and Iraq. The paper highlights diagnostic pearls and elements of management in a unique military context whilst relating these to a clinical everyday setting. Each of the six cases are described in detail, including the thorough evaluations they each underwent, often by multiple providers on separate occasions. In all cases, the diagnosis was initially elusive, however, following a detailed history, close follow-up and several carefully selected examination techniques, the diagnosis of NOVL was made. In several of the cases, a binocular visual field test proved useful in patients complaining of monocular visual field defects. In functional patients, the field defect often carries over to some degree on binocular visual field testing, whereas in true monocular field loss, the fellow eye compensates for the defective field to some degree. If the results from binocular testing were not clear cut, repeated testing showed significant variability in some of the patients in this case series. The authors also discuss the management of patients once a diagnosis of NOVL has been made, including psychiatric support, especially for this group who presented following exposure to combat.

Non-organic vision loss in the Afghanistan and Iraq conflicts.
Broderick KM, Ableman TB, Weber ED, et al.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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