Patients with metamorphopsia suffer from subjectively perceived visual disturbances. The cause of this phenomenon is usually psychological or neurogenic, and the visual disturbance can take different forms from distortions to changes in proportion. Treatment depends on the cause.
What is metamorphopsia?
From an evolutionary biology point of view, the sense of vision is one of the most important sensory systems in humans. Compared to other living creatures, the human visual system has ensured a survival advantage. Since the dawn of humankind, humans have sometimes relied most on perception through the eyes to assess dangers and opportunities in their environment. Humans are therefore considered to be eye-driven creatures. Since the sensory system, like all other sensory systems, corresponds to a highly complex, neuronally controlled system, disorders of the visual system occur relatively frequently. One group of visual disorders is metamorphopsia. This is a subjectively perceived visual disorder that is not necessarily due to physical causes. Metamorphopsia can occur in different forms. Examples are micropsia, macropsia, dysmorphopsia or teleopsia and pelopsia. Other forms are present with achromatopsia, chromatopsia, akineteopsia, and corona phenomenon. In each case, affected individuals report a distorted or otherwise altered perception of their surroundings. In addition to simple metamorphopsia, complicated metamorphopsia exists, which shows psychological effects.
Causes
Physical and psychological phenomena can be considered as causes of a subjectively perceived visual disorder. If physical pathogenesis is present, affected individuals suffer from either ocular disease or neurogenic disease. With neurogenic cause, metamorphopsia occurs mainly after damage to the optic nerve or visual pathways. These phenomena may be preceded, for example, by strokes or cerebral hemorrhage in the context of craniocerebral trauma. Inflammatory changes within the neuronal visual centers may also be neurogenic factors. Psychological causes may be present, for example, in the context of derealization. Derealization is a condition in which patients perceive their environment as distant, artificial, or inauthentic. Proportions, for example, may be perceived as incorrect. In most cases, derealization is accompanied by depersonalization. Such a state can occur, for example, when people are going through a life-threatening situation. Via derealization and depersonalization, the patient withdraws from the world or no longer perceives the world as real in order to protect him or herself from the life-threatening or otherwise traumatizing environmental events.
Symptoms, complaints, and signs
Various symptoms characterize metamorphopsia in individual cases. The patient’s condition depends on the form of metamorphopsia. In micropsia, the patient perceives his surroundings or individual details from them, for example, in reduced size. In macropsia, he sees details or the overall environment in magnification. In contrast, patients with dysmorphopsia experience their surroundings as misshapen and distorted. In teleopsia, the environment recedes into the distance, and in pelopsia, objects move unnaturally close. Patients with achromatopsia do not perceive colors. In chromatopsia, the color perception of individual objects or, as in cyanopsia, the overall environment changes. Patients with acineteopsia do not perceive moving objects at all, and in corona phenomenon, there is a colored border around individual objects in the environment. Especially in the case of an overall distortion of visual perception, psychological complaints often present themselves, such as anxiety or depressive mood. If the perceptual phenomenon is based on a psychological cause, accompanying symptoms usually include abnormal emotion.
Diagnosis and course of the disease
Characterization of any visual disorder includes differential diagnostic workup of the problem. The physician obtains the first clues to metamorphopsia in the medical history. In the course of diagnostics he narrows down the cause to the neurological, the ocular tissue or the psychological area. With this aim, a psychiatric evaluation of the patient is performed in addition to an ophthalmologic and neurological evaluation.Within ophthalmology, the Amsler test is available for the purpose of visual impairment diagnosis. The prognosis of patients varies depending on the cause. Neurogenic visual disorders sometimes have the worst chance of cure.
Complications
In most cases, metamorphopsia results in both psychological and physical limitations in the patient. Those affected primarily suffer from visual disturbances and visual complaints, although these occur due to psychological causes. Visual disturbances can have a very negative effect on the quality of life of the affected person and reduce it. Everyday life is also made significantly more difficult by these disorders, resulting in impairments in various activities. It is not uncommon for the visual complaints to lead to dizziness, nausea and the disturbance of concentration and coordination. Especially in children, metamorphopsia can lead to developmental disorders. Due to the disease, the outside world appears either enlarged or diminished for the patient. This can also lead to dangerous situations if the patient is unable to recognize or assess certain dangers. Furthermore, metamorphopsia usually occurs along with depression and anxiety. Sufferers may also suffer from epileptic seizures. A direct treatment of metamorphopsia is not possible, the treatment depends strongly on the psychological cause. It cannot be generally predicted whether a positive course of the disease will occur. As a rule, however, the patient’s life expectancy is not reduced by metamorphopsia.
When should one go to the doctor?
Metamorphopsia causes disturbances in vision. As soon as irregularities of vision occur or objects in the field of vision are perceived differently than by other persons present, a visit to the doctor should be made. Although metamorphopsia does not represent an organic irregularity or disorder of vision, a functional disorder of the eye must be examined and ruled out by medical tests. If the existing complaints increase in extent and intensity, a doctor is needed. Persistent disturbances are also a cause for concern and should be clarified. If the affected person notices an increased risk of accidents in everyday life due to impaired vision, caution is advised. Daily tasks should be restructured and optimized to avoid further problems, accidents or disturbances. If the affected person suffers from anxiety or panic due to the reduced vision, he or she should consult a doctor. If there is a reduced sense of well-being, headaches, digestive disorders or irritability, there is an irregularity that should be treated. Often the complaints are psychosomatic disorders that occur additionally due to the stresses and should be discussed with a doctor. Mood swings, behavioral abnormalities or withdrawal from social life are other signs that should lead to consultation with a physician.
Treatment and therapy
Treatment of patients with metamorphopsia depends on the underlying disorder. Different therapeutic approaches are in use for psychological causes such as derealization. Drug therapy is primarily intended to relieve patients’ fear of the distorted perceptions. In psychotherapeutic therapy, a cognitive-dynamic approach is often used. Patients learn to re-evaluate their visual perceptions and no longer perceive them as unreal or distorted. Subjective visual disturbance occurs in association with physical causes, especially in the context of an Alice in Wonderland syndrome. This syndrome often characterizes migraine attacks or epileptic seizures. In this context, patients’ metamorphopsia improves, provided the underlying disease improves. Affected individuals are usually treated conservatively with medications to delay the seizures. If scarring around the eyes is associated with the visual disorder, the scars are ablated as best as possible with a laser. Metamorphopsia due to right posterior brain damage is difficult to treat. Nerve tissue in the brain is highly specialized. Therefore, the brain usually cannot fully recover from damage.
Outlook and prognosis
The prognosis of metamorphopsia is determined by the underlying primary disease.A distinction must be made here as to whether the disorder is physical or psychological. With psychotherapeutic treatment and lifestyle changes, patients with psychological problems can achieve freedom from symptoms. There is also the possibility of damage to the transmitter. This is usually irreversible, so that relief of symptoms is often not achieved in the case of physical causes. In the case of neurogenic irregularities, a life-threatening condition may develop. If the disease progresses unfavorably, the patient is at risk of stroke or sudden bleeding in the brain area may occur. This increases the risk of premature death and presents an intensive care emergency. In the case of a mental disorder, it must be clarified how extensive it is. For some disorders, there is a possibility of a cure. In most cases, medications are given so that existing symptoms are alleviated. If cognitive changes take place at the same time, a cure can be achieved. However, the process is lengthy and success is tied to the patient’s cooperation. If severe mental disorders are present, there are usually no good prospects for recovery. Often, a chronic course of the disease is evident or there is an indivisibility of the disease.
Prevention
Psychologically induced metamorphopsia can be prevented by strengthening the patient’s psychological constitution. Improvement of the constitution can be achieved, for example, with timely psychotherapy in stressful situations.
Aftercare
Metamorphopsia can lead to various complications and discomforts if it is not treated or not treated properly. Therefore, in this disease, the affected person should seek medical attention at the first symptoms and discomfort to prevent further worsening of symptoms. As a rule, this disease also cannot heal itself, so a visit to a doctor is always necessary. In most cases, the person affected by metamorphopsia suffers from severe visual complaints. In this case, the size of different objects can no longer be represented correctly, so that there are strong difficulties and discomfort in everyday life. The perception of colors can also be severely disturbed. Many patients also develop depression or severe psychological upsets as a result of these complaints, and in children this can also lead to depression or bullying. It is not uncommon for those affected to also suffer from a loss of appetite or severe weight loss as a result. As a rule, the disease can be treated well, although the further course depends strongly on the time of diagnosis. In this context, the life expectancy of the affected person is usually not reduced by metamorphopsia.
What you can do yourself
The options for self-help and self-treatment for metamorphopsia are relatively limited. As a rule, those affected are always dependent on medical treatment to limit the symptoms. Psychological or therapeutic treatment of the disease is particularly suitable. In many cases, this can be supported and accompanied by discussions with friends or one’s own partner. Conversations with other sufferers of metamorphopsia can also have a positive effect on the course of the disease. Since patients often suffer from migraine and from epileptic seizures, no dangerous or strenuous activities should be carried out in everyday life. In the event of an epileptic seizure, an emergency physician should be called immediately. If the patient is responsive, the patient should be reassured. In case of loss of consciousness, regular breathing and stable lateral position should be ensured. Metamorphopsia can usually be avoided if the affected person recognizes psychological complaints or depression at an early stage and has them treated. This does not always require visits to a doctor. Clarifying conversations with the parents or with other close people often also help.