Medically unexplained visual loss

Sir,

We commend the authors¹ for a summary of the clinical characteristics of patients with ‘medically unexplained visual loss (MUVL)’. We are pleased to note that all their patients had neuroimaging given the resource constraints. Our experience of over two and half years in managing patients with MUVL is similar except for a much lower rate of neuroimaging due to resource constraints—a common problem in hospitals up and down the country. We find the following ‘checklist’ (Figure 1) very useful in documenting the clinical findings at each consultation. This ‘checklist’ not only guides the clinical examination based on presenting symptoms but also helps proper documentation—a vital part of defending the clinical decisions at a later date (especially if medico-legal issues arise). We place a lot of emphasis on reviewing the patient at regular intervals for at least 18 months and have a very low threshold for neuroimaging should the symptoms worsen during the review period.

Figure 1

Checklist.