Dr. Doug Cook has done a very nice job on his blog in putting together a synopsis about Streff Syndrome. We often associate this with generalized stress, and I’ve previously written about the intimate link between vision and emotions.
The tragic events that have unfolded at Penn State University have placed a very uncomfortable issue in our society front and center in today’s headlines. It is an issue that leaves indelible emotional scars on children and their families. An article in USA Today notes that one of the signs that might suggest abuse is changes in school performance that are otherwise inexplicable. Reading this makes one shudder at the thought of children who have come to our practice in the prime of their development, between the ages of 10 and 14 years, experiencing a precipitous drop in school performance. We’ve always considered hormones and emotional turmoil, but as ophthalmic practitioners we’d rather not let the thought of abuse as an etiology factor into our differential diagnosis.
Dr. Simon Barnard, a lecturer in the Department of Optometry & Visual Science at the City University in London, has written extensively on the subject of Visual Conversion Reaction (VCR). VCR is essentially the term used in the UK to describe so-called hysterical amblyopia first documented by Freud, a condition equivalent to Streff Syndrome. Barnard specifically lists sexual abuse as one of the possible etiologies of VCR. While there is danger in over-attribution of psychogenic origins of visual problems, at the very least VCR and Streff Syndrome must be considered expressions of post-trauma stress disorder.
It is uncomfortable, as a professional, to suggest to a parent that we have ruled out conventional sources of visual stress, and encourage the family to seek counseling for a child beyond visual treatment. Sadly current events remind us to keep abuse in our minds as one of the emotional origins precipitating changes in the visual performance of an individual presenting with VCR or Streff Syndrome.
– Leonard J. Press, O.D., FCOVD, FAAO