FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Positive Explanation of Preserved Vision and Follow-Up

Most likely fit: The person has an assessed functional visual-loss pattern and needs to understand the positive findings, remaining uncertainty and continuing-care plan. [Specialist clinical guidance; explanation is not a guaranteed vision-restoring treatment]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For the Person With FND

What this approach is for

A useful explanation begins with what the clinician found, not just a list of normal scans. Ask which examination findings support the diagnosis, what kind of vision they show, and what remains unexplained. You can ask for this in a short letter or accessible recording.

A response during one test does not mean that you can reliably see in every situation. It also does not mean you were pretending. Ask how the findings relate to the task that is difficult for you, such as reading a message or finding a doorway.

An explanation should end with a plan: who will answer questions, whether more assessment is needed, which support is available now and when follow-up will happen.

Terms in everyday language

Visual acuity means clarity of detail. Visual field means the area you can see around your point of focus. The retina is the light-sensitive tissue at the back of the eye; the optic nerve carries information toward the brain. Different tests examine different parts of seeing. One preserved ability cannot stand in for all of them.

Practical discussion and flare adaptations

Before an appointment, choose one everyday difficulty to explain. During the visit, ask the clinician to describe a finding in ordinary language and check that you understood it. If repeating a visual demonstration is uncomfortable, discussion can continue without doing the test again.

During a familiar flare, follow your safety plan rather than trying to prove the diagnosis by repeating tests. Stop hazardous activity and use assistance. A new loss of vision or changed pattern needs medical assessment even after FND has been diagnosed.

These examples require selection for your assessed presentation. The clinical rationale and its limits are described in the sources below. (Sources: 1, 2)

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Family, Friends, and Other Supporters

Listen to the person’s account of what they can and cannot experience. Ask whether they want help writing questions or remembering the plan. Avoid turning the explanation into “the doctor says you can see, so you should be able to do this.”

Support a second explanation or follow-up when uncertainty remains. If improvement occurs briefly, it does not invalidate the earlier disability; if it does not occur, that does not show rejection of treatment.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

For Clinicians and the Care Team

Selection and assessment

Confirm positive functional findings in the context of an appropriate ophthalmic and neurological assessment. Distinguish acuity loss, field loss and other phenomena. Do not generalize the visual-loss literature to diplopia, ocular-motor dysfunction or visual snow without a relevant assessment. Identify possible coexisting pathology rather than treating the functional diagnosis as its exclusion.

Explicit procedure

  1. Ask which visual difficulty and care question matter most to the person.
  2. Name the diagnosis and explain the specific positive finding, including its limitations.
  3. Offer a consented demonstration only if clinically useful and tolerable.
  4. Describe concurrent findings, pending investigations and uncertainty without using normal imaging alone as proof.
  5. Agree one functional goal and arrange practical support while treatment is considered.
  6. Give accessible written information and a follow-up contact; check understanding without making agreement a test of eligibility for care.

Review, progression and stopping

Review understanding, access and the next practical step. Avoid predicting recovery from acceptance, motivation or a single normal performance. Persisting visual disability deserves continuing assessment and support. Acute or substantially changed symptoms require a new safety decision, not reassurance based solely on an old diagnosis.

This is an educational implementation example, not a validated standalone treatment protocol. (Sources: 1, 2)

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

The 2024 review recommends a positive, transparent explanation and continuing involvement. The 2026 review identifies very limited treatment data. Neither establishes explanation alone as an effective standalone treatment for every patient.

Citation Full citation
[1] Ramsay N, McKee J, Al-Ani G, Stone J. How do I manage functional visual loss. Eye. 2024;38:2257–2266. FND-CIT-0024. Source
[2] Ramsay N, Tessmann H, McKee J, Ercoli T, Stone J. Functional visual loss: a systematic review and meta-analysis of epidemiology, prognosis and treatment. Eye. 2026;40:1784–1793. Published online June 26, 2026. FND-CIT-0103. Source

Source check: September 16, 2026 · Ophthalmology, neuro-ophthalmology, orthoptics, migraine, psychological, lived-experience, supporter and accessibility review pending.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —