• Doug Cook

Streff Syndrome

Streff syndrome (also known as non-malingering syndrome) is a functional vision problem that involves problems with focusing, eye teaming and eye movments both fast and slow (saccades and pursuits).  Authors such as Leonard Press  note this syndrome can be considered a form of amblyopia of an involuntary, psychogenic nature.

Amblyopia is a condition of underdeveloped vision.  Findings of underdeveloped vision can be considered a constellation (grouping) of findings that include lowered visual acuity, decreased accuracy and ability of ocular movements such as pursuits (slow eye movements) and saccades (fast eye movements), decreased focusing abilities and decreased visual processing skills.   Decreases in stereopsis (3D vision / depth perception) and restrictions in visual field (tunnel vision) can be measured clinically.   Most cases develop as a result of an eye turn (strabismus) or undercorrected refractive error.  Amblyopia can occur in 2.5% of the population, making it responsible for more loss of vision than all ocular diseases and trauma combined.

Streff syndrome is a different type of amblyopia labeled psychogenic.  This type is under-reported in the medical literature.  Psychogenic means the origin is in the mind or more accurately in the parts of the brain that help process vision.  Psychogenic amblyopia can involve voluntary and involuntary types.  Voluntary psychogenic amblyopia is also known as malingering – a process of faking a condition for some type of gain.  Involuntary psychogenic amblyopia involves vision and vision processing problems that occur in a patient who is not malingering.  Streff syndrome is considered an involuntary psychogenic amblyopia.     It’s considered a functional vision problem in otherwise healthy visual system.  Their problem is real, measurable and not being faked for some type of gain or attention.

There is no organic base for the problem meaning that there are no observed structural or anatomic anomaly that can account for the problem.  Saying that a problem is not organic however does not account for possible genetic, biochemical, electrophysiological or other abnormalities that may be present but for which we do not have the technology or background to identify them.  The word functional means that the normal expected work or function that a process is supposed to offer (such as correct focusing) does not occur.

Streff syndrome is believed to develop as a result of stress.  Hans Selye classifies stress as eustress – stress affiliated with change for the better such as marriage, getting an A on a test, being accepted into college or distress – stress affiliated with change for the worse such as divorce, family problems, substance abuse, emotional abuse, health problems.  A reaction from too much stress can include behaviors that trigger a person’s alarm mode especially if there is to0 much stress leading to an overload.

A diagnostic pattern has been described for patients susceptible to Streff syndrome.

  1. Prepubescent or early pubescent ages 10 – 14

  2. Females more frequent than males

  3. Visual acuity worse than 20/20 to  20/200

  4. Visual skills problems in ocular movements, ocular focusing and visual information processing.

Symptoms noticed by patients, parents and teachers can include:  a sudden decrease in academic performance, lack of desire to pursue homework, increased errors on homework, blurred vision at distance and at near, blurred vision of varying amounts which can come and go but usually stay blurry and headaches.

Sometimes the eye care professional can elicit a recent history of family stress, social stress, recent relocation or depression.  Some cases have been seen as a vision problem alongside post-traumatic stress disorders.  Treatment with lenses can help resolve the visual components involved.  Counseling and stress management may be needed if problems persist and social factors are identified.

The main clinical treatment of this condition is the use of a low plus eyewear prescription.  This may be in the form of reading glasses or a multifocal.  The effect of this prescription reduces the visual stress by just enough to allow the visual system to re-engage, organize and process information efficiently.  Results are usually quickly obtained with improvements seen within a few weeks.    Some cases may require vision therapy to improve eye movements and focusing.   In cases unresponsive, eye care professionals should always rule out organic pathology both at the time of the initial diagnosis and later on.

In 1962, Dr John Streff first published a description of this condition.  Articles in the optometric literature are more numerous than ophthalmological literature.  This condition needs more research.  The condition is considered functional in nature.  Functional means no organic pathology exists but the software programming of the visual system is inefficient or not working as it should.

More Information:  Streff Syndrome.pdf (an information pamphlet written by Paul Harris, OD on this condition)

Much of this information is adapted from: Press, Leonard. Applied Concepts in Vision Therapy, St. Louis:  Mosby 1997

Cook, Douglas T & Maples, WC. NSUOCO Vision Therapy Pocket Reference, Tahlequah:  SITE 1994

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