Metamorphopia

To adapt to the world around us, to orient ourselves, to learn it, analyzing and synthesizing the primary sensory-figurative reflections of objects and phenomena, allows us the ability of our brain to receive and transform the information coming through the senses. Perception (perception) is a complex process of psychosensory synthesis, including not only the primary analysis of objects and phenomena, but also the cognitive processing of their display. The mechanism of reflection of reality can be broken at any level of perception, and then the information is perceived by the individual in a distorted form. In contrast to hallucinations and illusions, metamorphosis is a disorder in the process of perceiving quantitative characteristics (number, size, shape, spatial distribution, speed, direction of movement, etc.) of actually existing and correctly identified objects. Distortion of information occurs after it has been, basically, correctly perceived at the level of organs of vision. In most cases, people critically assess their condition, understanding that their perception does not correspond to reality. This causes them to be perplexed and anxious about their condition, and in more severe cases makes them suffer from the inability to function normally in society.

[1], [2], [3], [4], [5], [6], [7], [8]

Epidemiology

The statistics of this phenomenon is not fully presented, since it is detected infrequently and in completely different diseases. It is believed that the probability of occurrence of metamorphobia does not depend on gender. Micropsia - the perception of the objects of the surrounding world is smaller than they are in reality, it is more common in children from five to twelve years old.

Refractive metamorphosis can be quite common, since astigmatism and myopia are often encountered, however, they are well corrected with glasses (lenses) or surgically, and therefore do not cause any particular inconvenience in everyday life. Pathology of the macula of the retina is also not too rare. However, with ophthalmologic diseases that cause a distorted perception of visual images, everything is more or less clear. With a successful vision correction, the patient's condition returns to normal.

Much more disturbing is the metamorphopia in people without pathologies of the organs of vision. Alice syndrome in Wonderland is often experienced by people with affective disorders. According to WHO statistics, every fourth inhabitant of the planet suffers to some extent from a mood disorder, mainly depressive. How many of them are confronted with the phenomena of metamorphopsia - is unknown.

[9], [10], [11], [12], [13]

Causes of the metamorphopia

Metamorphopia is not a separate disease. This perception phenomenon can be triggered by pathological changes in the organs of vision or diseases of the central nervous system.

The ophthalmologic causes causing this optical illusion are diseases of the retina that affect the macula in one way or another - the concentration of photosensitive cones (receptors). The resulting distortions of what they see are called receptor metamorphoses. For example, in inflammation of the choroid, an inflammatory infiltrate may squeeze this area of the retina.

Refractive metamorphosis occurs when the refractive power of the optical system of the organs of vision is disturbed, for example, astigmatism, high degrees of myopia.

The cause of the distortion of images can be diseases and injuries of the brain, intoxication psychoses, neuroses, affective disorders. In this case, in patients, as a rule, everything is all right with the organs of sight.

Any reasons that lead to the distortion of sensations, the assimilation of information, the violation of logical thinking, attention, memory, motivation can lead to disorders of visual perception.

Metamorphopsia can persist for a long time. The stability of the phenomenon indicates the seriousness and constancy of the cause that caused it.

Pathological distortion of reality can be a temporary phenomenon that occurs at any time of the day, however, it is often of a subsonic nature, that is, a violation of perception is noted at the time of going to sleep or awakening, and also is represented in dreams.

Short-term metamorphopsies can occur depending on the situations - occur after a nervous overstrain, arousal, stress. In epileptics, it is often noted after or precedes seizures.

Patients usually feel ephemeral of what is happening, alienation from it. Sometimes there is a feeling of duality of perception - the simultaneous existence of a correct and impaired assessment of perceived objects.

The risk factors for the occurrence of metamorphobia remain unclear to date and are determined after a thorough diagnosis of the patient who complained about the symptoms that concern him. Distorted perception accompanies functional and organic visual disorders (initial stage of cataract, astigmatism, high degree of myopia, choroiditis, retinal detachment); migraine with aura; disruption of the vestibular apparatus; organic pathologies of the occipital-parietal cortex (tumors, injuries, strokes); focal form of epilepsy; schizophrenia; severe infectious intoxication occurring with damage to the central nervous system. Distorted perception is characteristic of substance abusers.

Ephemeral short-term metamorphoses are often encountered in the practice of borderline psychiatry for hysteria, neurosis, affective and reactive states (often in the symptom complex of depersonalization / derealization syndrome). In such patients, visual impairment is usually not detected. Purely neuropsychiatric manifestations of a distorted self or world view is also called Alice’s syndrome in Wonderland.

[14], [15], [16]

Risk factors

Corresponding clinical manifestations often occur on the background of focal lesions of the cerebral cortex areas responsible for the perception of the physical characteristics of objects and phenomena — neuronal activity locally changes, accelerates or slows down, which leads to distorted perception.

An infection (inflammation of the retina of the eye or of the meninges) can be a trigger for the emergence of this phenomenon; injuries - craniocerebral, intraocular; mental illness; substance abuse, stressful events, etc.

Modern research suggests that the distortion of the shape and size of perceived objects is characteristic of lesions of the interparietal sulcus of the brain, which plays a significant role in the synthesis of the sensory material obtained.

The violation of the activity of the frontal lobes of the brain, which allows differentiation of the foreground and background objects, as well as the occipital - participating in orientation in space, is also considered. For example, increased neuronal activity in the frontal lobes of the brain is associated with abnormal perceptions that occur with migraine with aura.

The International Classification of Diseases classifies metamorphopia to the class of eye diseases and treats it as a “subjective visual disorder,” however, in many cases, the incorrect perception of objects and phenomena is due to purely neurological reasons.

[17], [18], [19], [20], [21]

Pathogenesis

The pathogenesis of metamorphopia, respectively, is very diverse and has not been authentically studied. The visual perception of the object may be distorted due to the pathology of the photosensitive receptors of the macula, refractive disorders, that is, caused by ophthalmic causes. In this case, the human nervous system suffers from the inconvenience associated with dysfunction of the organs of vision. In the absence of their defeat, this pathology is considered as a malfunction of the central mechanisms of the cerebral apparatus.

[22], [23], [24], [25], [26]

Symptoms of the metamorphopia

The first signs of frustration appear unexpectedly and rarely leave the patient indifferent to the metamorphosis undergoing. Especially if the state does not let go. Distorted perception of parts of his own body or objects of the world around him, less often - both of them immediately cause at least bewilderment, and more often - thoughts of insanity.

Short-term metamorphopsies are easier to survive, and long-term disorders that do not go away for several hours or days can cause the patient complete disorientation, panic, and loss of ability to control his behavior.

Complaints of patients look like this: "the head has become so big that it does not fit in the room"; "The objects around suddenly become small, as for the Liliputians" or "the cabinet walls became wavy."

Distortion can affect only parts of the body of the individual - autometamorphism; objects surrounding it - allometamorpopsia. They can be perceived disproportionately large - macropsies or very small - micropsia. The distortion of the size of objects, the inconsistency in the size of their parts, various deformations, bends, apparent change in texture, asymmetry is collectively called dismegalopsy. It can be a symptom of accommodation paralysis, macular dystrophy, as well as mental disorders (one of the main manifestations of Alice’s syndrome).

Metaphoresia can be expressed in the distortion of the distance to the observed object, the shape and size of which are perceived correctly. It seems to the patient that it is located much closer or further than it actually is. This form of distortion is called porropia. It may indicate both retinal degeneration and damage to the parietal and occipital lobes of the cerebral cortex.

Often, patients perceive objects as larger and closer than they actually are (macro-teleops) or smaller and more remote (micro-teleops).

If a single object literally multiplies before the eyes of the patient, this disorder is called polyopia. It can be a symptom of incipient cataracts, keratoconus, other ophthalmic pathologies affecting the cornea or lens.

In people with normal vision, polyopia can occur with hysterical disorders.

Focal lesions of the cerebral cortex and focal epilepsy are often manifested as a syndrome of spatial rotation. Objects located on one side of the observer are perceived by them on the other. The turn can be at different angles, often 180 °, for example, objects or people walking in front are perceived as being behind. Cases and rotations through 90 ° are described - for example, an object located in front of an observer is perceived as being to the right or left of it. As well as objects are rotated both vertically and horizontally.

Incorrect assessment of the location of the object is called optical allelestia. The patient may complain that, looking at his own reflection, he feels him behind his back, or who is walking nearby feels far advanced or significantly lagging behind. Allestesia can be olfactory (the patient cannot correctly locate the source of the smell) or acoustic (the source of the sound).

Symptoms are very diverse, sometimes the same patient has a distorted perception of himself (auto) and the surrounding world (hallo). Such a condition is referred to as ambivalent metamorphosia.

There is also chronopsy - a distorted perception of time, a mismatch in projecting certain events into periods of time.

[27],

Complications and consequences

Distortion of the usual ideas about the environment and oneself, especially long and stubborn, causes significant discomfort and can lead to complete disorientation.

For example, an incorrect assessment of the distance to objects, the direction of their movement leads to difficulties in performing such simple actions as sitting on a chair or putting something on the table. Going through the street for people with spatial metamorphobia becomes life threatening.

In addition, a symptom such as a distorted perception of one’s body and / or the surrounding world may indicate that the patient has serious mental illnesses - schizophrenia, epilepsy, or a brain tumor. Metamorphopia in patients with diabetes mellitus may indicate the development of serious complications associated with vascular lesions of the retina. Sometimes it is the vision distortion that occurs in the early stages of the disease, allows us to diagnose diabetes in time.

Any, even short-term manifestations of metamorphopia should not be ignored, because whatever they were caused - this is evidence of trouble.

[28], [29], [30], [31], [32],

Diagnostics of the metamorphopia

The basis for the examination are patient complaints. If the ophthalmologic causes of visual image distortion can be identified with the help of special tables and tests, in particular, the Amsler test and hardware methods such as refractometry, ophthalmometry, ophthalmoscopy, ultrasound of the eyeball and others are used, that is, patients complain about the distorted vision of objects.

In cases of psychosensory disorder, patients often experience abnormal sensations and with eyes closed. In most cases, metamorphopia is combined with other psychopathological symptoms - anxiety, inability to take targeted actions, movements, reasoning, the occurrence of panic attacks.

To identify the underlying disease, various laboratory (analysis of the contents of the spinal puncture) and instrumental methods (EEG, computed and magnetic resonance imaging) studies are used, depending on the intended diagnosis.

[33], [34]

Differential diagnosis

A differential diagnosis is carried out to establish the cause of this disorder. Autometamorphism in  focal epilepsy  or  schizophrenia is  distinguished from conditions that have arisen as the consequences of suffering serious infectious diseases, pathologies of cerebral vessels, intracranial tumors or head injuries. Limit the metamorphopsy caused by chronic or acute alcohol (drug) intoxication.

[35]

Treatment of the metamorphopia

Metamorphic therapy is determined by the nature of the underlying disease. Drugs that would help all at once to get rid of metamorphopia, have not yet been invented. The effectiveness of treatment depends on the correct determination of the original source of distorted perception.

Depending on the results of diagnosis, different treatment methods are used. In case of inflammatory diseases of the choroid and retina, drug therapy is prescribed depending on the identified pathogen - antibacterial, antiviral, antiparasitic, anti-inflammatory. Locally apply eye drops, can be prescribed systemic therapy, drug electrophoresis.

In diabetic retinopathy, the focus is on stabilizing blood glucose values.

Refractive disorders are corrected by selecting suitable optics. If necessary, conduct surgical interventions, apply cryo-and laser therapy.

Degenerative age-related diseases are also quite successfully corrected through operations.

The main drugs used to treat schizophrenia are neuroleptics. Their patients are usually taken throughout their lives, which allows them to maintain its quality at an almost normal level.

Epileptics are prescribed courses of anticonvulsant therapy, brain tumors are removed by surgery.

Analgesics can help patients with vegetovascular dystonia, migraines, menigoencephalitis, sedatives of plant origin or antidepressants can help with affective disorders. For disorders of cerebral circulation, hypoxia, the effects of intoxication and injury, drugs with nootropic activity are used.

In conjunction with drug therapy, psychocorrection is used - coursework with a psychologist is conducted in the form of group classes or according to an individual program. They are focused on restoring impaired thinking functions.

[36], [37], [38]

Prevention

To prevent the emergence of metamorphopia in healthy people is possible by following the general recommendations to strengthen their own body. An active lifestyle, good nutrition will allow you to avoid infectious diseases or move them in a mild form.

Optimization of the mode of work and rest will contribute to a rational distribution of physical, mental, visual load, increase stress resistance. Positivism and optimism will help to avoid traumatic situations.

Eradication of bad habits guarantees the absence of alcoholic and / or narcotic psychosis. Even the likelihood of injuries, severe infections and tumors, as well as migraines and affective states among fans of a healthy lifestyle, is much lower.

For people with chronic diseases, the main preventive measure is regular medical supervision, timely diagnosis and conscientious implementation of all recommendations of the attending physician.

[39], [40], [41], [42], [43]

Forecast

Modern ophthalmology has a sufficient arsenal of tools to help patients with distorted perception of objects of vision.

Psychosensory disorders are also amenable to correction. Even in the presence of mental illness, drug-compensated states of prolonged remission occur in the vast majority of cases. However, the final prognosis for recovery depends on the cause of the metamorphopia.

[44], [45],