FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Orthoptist-Guided Visual Feedback

Most likely fit: A specialist has identified a specific preserved visual response that can be explained and explored safely during an appointment. [Specialist clinical practice; direct treatment evidence is limited]

For the Person With FND
For Family, Friends, and Other Supporters
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For the Person With FND

What this approach is for

An orthoptist assesses how the eyes work together and aspects of visual function. With an ophthalmologist or neuro-ophthalmologist, they may select a task that makes an available visual ability easier to notice.

Examples in specialist practice include comparing a single letter with a crowded row, assessing how the eyes combine information, or explaining a response obtained with clinical lenses. The equipment is chosen for a reason; buying prisms or copying a video is not equivalent to this assessment.

Terms in everyday language

Binocular vision uses information from both eyes. Stereopsis is depth perception based on differences between their views. Saccades are quick changes in where the eyes look. A prism changes the direction of light. These terms describe different functions, not interchangeable ways to treat visual loss.

Practical discussion and flare adaptations

Ask what the proposed demonstration is intended to show and whether it may provoke headache, dizziness or double vision. You can pause or decline it. If an easier task is found, ask how it connects to a real need and which parts, if any, are safe to practise outside the clinic.

During a familiar visual flare, use only the agreed home adaptation. Do not improvise patching, lens changes, moving patterns or binocular exercises. Keep your usual support for getting around.

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
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For Family, Friends, and Other Supporters

Help communicate light, sound or motion sensitivity before the appointment. Do not reproduce examination tests at home to prove that vision is available. A clinician may interpret a response that the person still cannot consciously experience.

If a demonstration is upsetting or physically uncomfortable, support stopping and asking for an explanation. Avoid pressure to display the same response for other family members.

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

Specify the deficit being investigated and distinguish diagnostic demonstration from therapeutic repetition. Check refraction, alignment, acuity, binocular status, visual fields and relevant ocular/neurological disease as indicated. Preserved stereopsis or a particular eye movement does not establish all aspects of reliable everyday vision.

Explicit procedure

  1. Review the positive diagnosis and identify one relevant visual function.
  2. Explain the task and obtain consent, including the option not to repeat it.
  3. Select an assessment within professional competence: for example, single versus crowded optotypes or a suitable binocular demonstration.
  4. Describe what the response supports and what it cannot show; avoid deception and claims about effort.
  5. If a task is useful, adapt it to a brief seated functional activity without unnecessary provocative input.
  6. Write down any approved home task, stopping criteria and follow-up; retain specialist control of clinical lenses, occlusion and interpretation.

Review, progression and stopping

Record task-specific function, discomfort, fatigue and transfer to everyday use. Withdraw the chosen feedback if it increases symptoms or confusion. Do not escalate to flickering, rapidly moving or stereoscopic material merely because another person tolerated it. New diplopia or other changed symptoms require assessment.

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
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Research and Sources

The 2024 review proposes turning selected diagnostic demonstrations into transparent therapeutic opportunities. It does not establish a standard orthoptic programme for functional visual loss. Evidence for exercises for other eye conditions cannot be transferred automatically to FND.

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 —