Metamorphopsia in neurological practice

Metamorphopsia is distortion of the visual perception of environmental objects (shape, sizes, orientation, color, and/or motion parameters), but without affecting their essential characteristics. It can be observed in the clinical picture of a number of diseases, interfering with daily activities and restricting the behavior of patients due to fear of its sudden occurrence. However, the importance of metamorphopsia is underestimated in practice, which is associated with both patients' tendency to be reticent about it and with physicians' unawareness about this condition. The review presents the classification of visual distortions, the clinical characteristics of peripheral (in eye structural pathology) and central (in brain damage) metamorphopsia. The most detailed discussion focuses on palinopsia. The Pulfrich phenomenon and the visual snow symptom are briefly described. The review considers metamorphopsia concurrent with illusions in the Alice-in-Wonderland syndrome. It characterizes the neurophysiological mechanisms of distorted vision and the pathology in which the latter can occur. There is evidence that it is important to timely detect metamorphopsia.

1. Blom JD. Defining and measuring hallucinations and their consequences – what is really the difference between a veridical perception and a hallucination? Categories of hallucinatory experiences. In: Collerton D, Mosimann U, Perry E, editors. The Neuroscience of Visual Hallucinations. Wiley-Blackwell; 2015. P. 23-45.

2. King DJ, Hodgekins J, Chouinard PA, et al. A review of abnormalities in the perception of visual illusions in schizophrenia. Psychon Bull Rev. 2017 Jun;24(3):734-751. doi: 10.3758/s13423-016-1168-5.

3. Jü rgens TP, Schulte LH, May A. Migraine trait symptoms in migraine with and without aura. Neurology. 2014 Apr 22;82(16):1416-24. doi: 10.1212/WNL.0000000000000337. Epub 2014 Mar 21.

4. O'Toole P, Modestino EJ. Alice in Wonderland Syndrome: a real life version of Lewis Carroll's novel. Brain Dev. 2017 Jun; 39(6):470-474. doi: 10.1016/j.braindev.2017.01.004. Epub 2017 Feb 8.

5. Tokida H, Takeshima S, Takeshita J, et al. A case of various illusion and hallucination caused by occipital lobe infarction. Rinsho Shinkeigaku. 2018 Sep 28;58(9):556-559. doi: 10.5692/clinicalneurol.cn-001081. Epub 2018 Aug 31.

6. Soulas T, Cleret de Langavant L, Monod V, Fenelon G. The prevalence and characteristics of hallucinations, delusions and minor phenomena in a non-demented population sample aged 60 years and over. Int J Geriatr Psychiatry. 2016 Dec;31(12):1322-1328. doi: 10.1002/gps.4437. Epub 2016 Feb 14.

7. Kim JW, Kim YT. Clinical application of 3D display device in ophthalmology: measurement of metamorphopsia. Acta Ophthalmol. 2016 Feb; 94(1):e54-8. doi: 10.1111/aos.12795. Epub 2015 Jun 24.

8. Nour MM, Nour JM. Perceptual distortions and deceptions: what computers can teach us. BJPsych Bull. 2017 Feb;41(1):37-40. doi: 10.1192/pb.bp.115.052142.

9. Blom JD. The Alice in Wonderland syndrome. What do we know after 60 years? Tijdschr Psychiatr. 2016;58(4):281-91.

10. Midena E, Vujosevic S. Metamorphopsia: an overlooked visual symptom. Ophthalmic Res. 2015;55(1):26-36. doi: 10.1159/000441033. Epub 2015 Nov 11.

11. Lewis SJ, Shine JM, Brooks D, Halliday GM. Hallucinogenic mechanisms: pathological and pharmacological insights. In: Collerton D, Mosimann U, Perry E, editors. The Neuroscience of Visual Hallucinations. Wiley-Blackwell; 2015. P. 121-150.

12. Shepherd AJ, Joly-Mascheroni RM. Visual motion processing in migraine: Enhanced motion after-effects are related to display contrast, visual symptoms, visual triggers and attack frequency. Cephalalgia. 2017 Apr;37(4):315-326. doi: 10.1177/0333102416640519. Epub 2016 Apr 22.

13. Bae SH, Kim D, Park TK, et al. Preferential hyperacuity perimeter and prognostic factors for metamorphopsia after idiopathic epiretinal membrane surgery. Am J Ophthalmol. 2013 Jan;155(1):109-117.e3. doi: 10.1016/j.ajo.2012.07.007. Epub 2012 Sep 27.

14. Bae SW, Chae JB. Assessment of metamorphopsia in patients with central serous chorioretinopathy. Indian J Ophthalmol. 2013 Apr;61(4):172-5. doi: 10.4103/0301-4738.112162.

15. Wiecek E, Lashkari K, Dakin SC, Bex P. Novel quantitative assessment of metamorphopsia in maculopathy. Invest Ophthalmol Vis Sci. 2014 Nov 18;56(1):494-504. doi: 10.1167/iovs.14-15394.

16. Kinoshita T, Imaizumi H, Okushiba U, et al. Time course of changes in metamorphopsia, visual acuity, and OCT parameters after successful epiretinal membrane surgery. Invest Ophthalmol Vis Sci. 2012 Jun 14;53(7):3592-7. doi: 10.1167/iovs.12-9493.

17. Okamoto F, Sugiura Y, Okamoto Y, et al. Metamorphopsia and optical coherence tomography findings after rhegmatogenous retinal detachment surgery. Am J Ophthalmol. 2014 Jan; 157(1):214-220.e1. doi: 10.1016/j.ajo.2013.08.007. Epub 2013 Oct 5.

18. Manabe K, Osaka R, Nakano Y, et al. Metamorphopsia associated with central retinal vein occlusion. PLoS One. 2017 Oct 19;12(10): e0186737. doi: 10.1371/journal.pone.0186737. eCollection 2017.

19. Osaka R, Manabe K, Manabe S, et al. Persistent metamorphopsia associated with branch retinal vein occlusion. PLoS One. 2018 Sep 20;13(9):e0204015. doi: 10.1371/journal.pone.0204015. eCollection 2018.

20. Mojon DS, Rö sler KM, Oetliker H. A bedside test to determine motion stereopsis using the Pulfrich phenomenon. Ophthalmology. 1998 Jul;105(7):1337-44.

21. Rae-Grant AD. Unusual symptoms and syndromes in multiple sclerosis. Continuum (Minneap Minn). 2013 Aug;19(4 Multiple Sclerosis):992-1006. doi: 10.1212/01.CON.0000433287.30715.07.

22. Farr J, McGarva E, Nij Bijvank J, et al. The Pulfrich Phenomenon: Practical Implications of the Assessment of Cases and Effectiveness of Treatment. Neuroophthalmology. 2018 Apr 25;42(6):349-355. doi: 10.1080/01658107.2018.1446537. eCollection 2018 Dec.

23. Lerner AG, Lev-Ran S. LSD-associated "Alice in Wonderland Syndrome"(AIWS): A Hallucinogen Persisting Perception Disorder (HPPD) Case Report. Isr J Psychiatry Relat Sci. 2015;52(1):67-8.

24. Stagno SJ, Gates TJ. Palinopsia: a review of the literature. Behav Neurol. 1991;4(2):67-74. doi: 10.3233/BEN-1991-4202.

25. Gersztenkorn D, Lee AG. Palinopsia revamped: a systematic review of the literature. Surv Ophthalmol. 2015 Jan-Feb;60(1):1-35. doi: 10.1016/j.survophthal.2014.06.003. Epub 2014 Jul 2.

26. Huang M, Baskin DS, Fung S. Glioblastoma Presenting with Pure Alexia and Palinopsia Involving the Left Inferior Occipital Gyrus and Visual Word Form Area Evaluated with Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging Tractography. World Neurosurg. 2016 May;89:725.e5-725.e10. doi: 10.1016/j.wneu.2015.12.071. Epub 2015 Dec 31.

27. Ziaei M, Elgohary MA, Bremner FD. Palinopsia as the initial manifestation of nonHodgkin's lymphoma. Int Ophthalmol. 2013 Oct;33(5):553-6. doi: 10.1007/s10792-012-9682-6. Epub 2012 Nov 29.

28. Sierra-Hidalgo F, de Pablo-Fernandez E. Palinopsia induced by topiramate and zonisamide in a patient with migraine. Clin Neuropharmacol. 2013 Mar-Apr;36(2):63-4. doi: 10.1097/WNF.0b013e3182849208.

29. Danilova NN. Psikhofiziologiya: Uchebnik dlya vuzov [Psychophysiology: Textbook for universities]. Moscow: Aspekt Press; 2012.

30. Fine EJ. The Alice in Wonderland syndrome. Prog Brain Res. 2013;206:143-56. doi: 10.1016/B978-0-444-63364-4.00025-9.

31. Lanska DJ, Lanska JR. The Alice-inWonderland Syndrome. Front Neurol Neurosci. 2018;42:142-150. doi: 10.1159/000475722. Epub 2017 Nov 17.

32. Todd J. The syndrome of Alice in Wonderland. Can Med Assoc J. 1955 Nov 1; 73(9):701-4.

33. Liu AM, Liu JG, Liu GW, Liu GT. «Alice in wonderland» syndrome: presenting and followup characteristics. Pediatr Neurol. 2014 Sep; 51(3):317-20. doi: 10.1016/j.pediatrneurol.2014.04.007. Epub 2014 Apr 12.

34. Kadia BM, Ekabe CJ, Agborndip E. Primary care challenges of an obscure case of «Alice in Wonderland» syndrome in a patient with severe malaria in a resource-constrained setting: a case report. Pediatr Neurol. 2014 Sep; 51(3):317-20. doi: 10.1016/j.pediatrneurol.2014.04.007. Epub 2014 Apr 12.

35. George D, Bernard P. Complex hallucinations and panic attacks in a 13-year-old with migraines. The Alice in Wonderland syndrome. Innov Clin Neurosci. 2013 Jan;10(1):30-2.

36. Chou HW, Chang HA, Huang SY, Tzeng NS. Complex visual illusions in a patient with pituitary apoplexy. Gen Hosp Psychiatry. 2013 Sep-Oct;35(5):e5-6. doi: 10.1016/j.genhosppsych.2012.10.003. Epub 2012 Nov 20.

37. Simpson JC, Goadsby PJ, Prabhakar P. Positive persistent visual symptoms (visual snow) presenting as a migraine variant in a 12-year-old girl. Pediatr Neurol. 2013 Nov; 49(5):361-3. doi: 10.1016/j.pediatrneurol.2013.07.005. Epub 2013 Aug 19.

38. Schankin CJ, Maniyar FH, Digre KB, Goadsby PJ. 'Visual snow'-a disorder distinct from persistent migraine aura. Brain. 2014 May; 137(Pt 5):1419-28. doi: 10.1093/brain/awu050. Epub 2014 Mar 18.

39. White OB, Clough M, McKendrick AM, Fielding J. Visual Snow: Visual Misperception. J Neuroophthalmol. 2018 Dec;38(4):514-521. doi: 10.1097/WNO.0000000000000702.

40. Laukkanen H, Scheiman M, Hayes JR. Brain Injury Vision Symptom Survey (BIVSS) Questionnaire. Optom Vis Sci. 2017 Jan;94(1): 43-50. doi: 10.1097/OPX.0000000000000940.

41. Berthold-Lindstedt M, Ygge J, Borg K. Visual dysfunction is underestimated in patients with acquired brain injury. J Rehabil Med. 2017 Apr 6;49(4):327-332. doi: 10.2340/16501977-2218.