From: "Dr. Larry Baitch" <baitch19@idt.net>
To: CVNetList@lawton.ewind.com
Subject: Follow-up on Stress and Visual Dysfunction
When I was the neurosensory diagnostician in the Department of
Ophthalmology at Sinai Hospital in Detroit, I was referred a patient, a
15 year-old girl who was a straight "A" student and captain of her high
school archery team in urban Detroit. Two adverse incidents occurred to
her within a week: she was assaulted at knifepoint and a few days later
witnessed her best friend gunned down in a drive-by gang shooting.
Her psychic traumas resulted in psychiatric hospitalization. She
concurrently had a profound loss of vision, reduced to finger counting,
with overall depression of the visual fields and more significant
altitudinal losses similar to those seen in non-arteritic ischemic
neuropathy. Over the period of months her vision had degraded to hand
motion.
With all other ophthalmnic disease ruled out, her doctors felt strongly
that her visual losses were hysterical in nature due to her trauma. She
was referred to me to rule out hysteria or malingering.
Her (very closely observed) neurosensory workup showed severely
depressed and slightly delayed flash VEPs, nearly extinguished pattern
VEPs and reduced flash ERGs. All attempts to detect malingering were
negative, including a lack of tubular or spiral fields. Follow-up
testing a few months later yielded identical results.
After about a year she was declared legally blind and is receiving
services from the Michigan Commission for the Blind.
Our best guess was that this sudden, physiological loss of vision
coincident with her profound psychological trauma may have been caused
by stress-induced vascular spasm and ischemia.
-Larry Baitch
*********************************************
Lawrence W. Baitch, O.D., Ph.D.
Vice-President for Clinical and Technical Services
American Medical Vision Technology
Phone: (734)243-9834 X245 (office)
(734)930-9629 (home)
Fax: (734)243-3236
Website: www.amvtlaser.com
E-mail: baitch19@idt.net
*********************************************
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