Tips For Managing Patients

Emphasize the positive: Establish a therapeutic relationship with the patient where the positive aspects of the encounter are emphasized. For example, reassure patients that the eye and central nervous system are not damaged, rather than using phrases like “there is nothing wrong,” which can seem dismissive.

Follow-up: Offer a follow-up visit to most patients so that they do not feel dismissed. This also ensures that a nonorganic component of the examination has
not obscured an underlying organic process.

Psychiatric referral: It is the role of the ophthalmologist to clearly communicate the nature of the vision loss to the referring physician and primary care physician. Determining the need for psychiatric referral should generally be deferred to the patient’s primary care physician, who typically has a longer standing relationship with the patient. Most patients with NVL do not appear to benefit from talk therapy. 

Be aware of cognitive bias: Some authors suggest that certain personality traits (overly aggressive or passive) or habits (wearing sunglasses in a dimly lit examination room) can suggest NVL, but it is important to remember that these features are not reliable indicators and may be potential sources of cognitive bias on the examiner’s part.