Hysterical Amblyopia is a syndrome that is characterized by reduced visual acuity not caused by any type of eye disease. It is 4 times more prevalent in girls and shows a peak in incidence between the ages of 11 to 14. A number of symptoms cluster together, with vision changes noticed first at near distances when reading, often with a sudden onset. In some children there may be no complaints about vision even with marked reductions in vision. Accompanying the reduced vision there is frequently a lowering of depth perception as tested by stereoscopic methods, a reduction in color vision test scores, and tunnel vision. When tunnel vision is present it is in a form that is not possible from a physiological perspective, and there is no corresponding loss of peripheral mobility (the child is not bumping into objects as they walk. It can be a result of stress in the child’s environment. Other symptoms may be present such as headaches and light sensitivity.
Streff Syndrome is used to describe similar problems that are thought to be caused by the visual stress of near work. Some Eye Doctors make a sharp distinction between the two conditions, I feel they are the same, caused by stress whether it is in the family environment, related to intense near work, or both.
Treatment opinions vary greatly. Visiting a therapist to rule out any serious psychological issues in a good step. Various forms of lenses and tints may be used. Some Optometrist believe low prescriptions to help the eye focus are useful. I believe these are usually placebo effects but fall in the category of active placebos. A school of thought exists that not all placebos are equal and choosing the correct placebo can aid in healing a number of health problems. Frequently the lens and tint options we use can resolve the problem in a matter of weeks or months. Sometimes eye exercises are used. Occasionally drops are used. Other alternative therapies can be used, the most well known being the Irlen System. However, I have found the tints we use to be just as effective.
Malingering occurs when a child wants glasses and feigns vision loss. It is difficult for a child to be successful malingering with the eye exams we utilize today. Hysterical Amblyobia is not malingering, it is a true psychologically related vision loss. Left untreated hysterical amblyopia may continue throughout life. It may also spontaneously disaapear as stress reduces.
It is vitally important to follow up with appoinments and make sure the condition is not getting worse. I have seen one case of hysterical ambyopia tha occurred at the same time a pituitary tumor was developing. Follow up visits allow us to make sure that no rare cases of co-exsisting serious conditions exsist. Although it is normally done only at research centers, electrophysiological testing can help in the definitive diagnosis of hysterical amblyopia.