FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Supported Visual Choice Without Waiting for Certainty

Most likely fit: A clinician-selected matching or pointing task may reveal usable information even when the person cannot confidently describe what they see. [Specialist clinical example; experimental therapeutic use rather than a validated home test]

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

Sometimes a clinician may invite you to point or match even when you are unsure. The invitation should be explained openly: “You can choose if you want, and it is fine not to know.” It is not a demand to guess correctly or prove that you are honest.

The task is optional. If uncertainty becomes upsetting, if you feel interrogated or if the task worsens symptoms, it can stop. Ordinary care and support do not depend on completing it.

Terms in everyday language

Visual perception is the experience of seeing. A choice response is an action such as pointing to one of two locations. These are related but not identical. Chance, understanding, hearing, memory and movement can all influence a response; one correct choice does not establish normal vision.

Practical discussion and flare adaptations

A clinician might present two simple alternatives in a comfortable seated setting and invite a point or match. They should provide neutral feedback and explain why a short trial may be informative. Avoid repeated challenges after an error or after a response that the person cannot reproduce.

This method must never be used to decide whether it is safe to cross a road, handle medicine, identify hot water or navigate stairs. During a flare, stop testing and follow the agreed safety plan. A guessed location is not reliable functional vision.

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

Do not turn household activities into guessing games without agreement. Never say that an accurate answer means the person was pretending or withholding effort.

Support an alternative way to communicate if pointing or speech is difficult. A refusal, uncertain response or wrong answer must not change the support offered.

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

Distinguish a therapeutic invitation from a formal psychophysical forced-choice assessment. Control task demands, cueing and accessibility where relevant. Neither a single above-chance response nor poor performance is sufficient to infer mechanism, intentionality or prognosis. Positive diagnostic conclusions require the full clinical assessment.

Explicit procedure

  1. Identify why a low-certainty choice could help this person’s agreed rehabilitation goal.
  2. Explain the task and the right to pass or stop.
  3. Use a small number of simple, safe choices in a stable seated setting.
  4. Record the response without equating accuracy with conscious visual experience or normal vision.
  5. Offer transparent feedback and ask whether the task was useful or uncomfortable.
  6. Continue only if it supports a meaningful activity; do not assign repeated home testing to supporters.

Review, progression and stopping

Review tolerability and practical value. Stop if guessing becomes pressured, distressing or a source of family conflict. The absence of a useful response should change the method, not the clinician’s respect for the person’s symptoms. This page supplies no diagnostic cut-off or mandatory repetition count.

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 includes supported guessing among illustrative specialist approaches. This is not a validated standalone intervention, and findings from individual vignettes cannot establish its effectiveness or identify feigning.

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 —