Ocular malingering
| Ocular malingering | |
|---|---|
| Specialty | Ophthalmology, Optometry |
| Diagnostic method | Eye examination |
| Differential diagnosis | Functional visual loss, Amblyopia |
Ocular malingering is a type of malingering in which patients may either simulate a visual complaint, or they may deny a visual complaint or ophthalmic disease. A person may simulate variety of visual complaints including uniocular or binocular blindness, visual field defect or night blindness. A similar condition is functional visual loss which come under the spectrum of functional neurological disorder or somatic symptom disorder.
Overview
[edit]Ocular malingering is seen in a variety of patients despite age sex or ethnicity. Patients may either simulate an ophthalmic disease (positive simulation or positive malingering), or they may deny a visual complaint or ophthalmic disease (negative simulation or negative malingering).[1][2] The most common malingerer is faking vision loss to gain disability benefits, or attention, among other secondary benefits.[3] A second group of people exaggerates their visual symptoms, knowing they are exaggerating their symptoms but worrying that they may actually have a serious vision problem.[3] The third type of person feels sure that something is wrong with his eyes and tries to help the doctor to identify the disease easily without hiding the symptoms of his disease.[3] The last type of person often finds satisfaction in telling himself that he is blind in one eye, or that he has tunnel vision, after minor injuries.[3] Rarely, a person may pretend to be completely blind in both eyes.[2] Patients may also simulate visual field defects, diplopia, color blindness, night blindness or ocular motility disorders.[4]
People may malinger to get financial benifits from others, to get sympathy from others, to get some particular jobs, or to escape from certain jobs or police cases.[5] Malingering is not considered a psychiatric disorder, but rather a deliberate attempt to deceive and manipulate others for personal gain.[6]
History taking
[edit]History taking very important in assessing ocular malingering. It is very important not to allow any friend or relative into the examination room as the presence of another can influence the patient's behavior and thereby the diagnosis.[1] It is also important that the patient never feels that the examiner suspect the patient is malingering, as this will make the patient more alert.[1] So as usual do the exam calmly and quickly as routine work.
All complaints, including conflicting ones, as well as all symptoms reported by the patient should be recorded in their own words.[1] Time of entry into the room, state of mind upon entering the room, type of seating, psychological profile and reactions should be recorded.[1] Those records may sometimes be required in future judicial investigations.[1]
Diagnosis
[edit]Diagnosis is mainly through eye and vision examination. But a psychological approach based behaviour of the individual and the reaction of the patient during examination should also be noted.[7]
Optometrists and ophthalmologists perform a number of tests to determine if a person has a serious vision loss or if they are lying. The types of tests vary depending on the type of vision loss the patient complains. All ophthalmic sensory and motor functions should be checked, including a visual acuity test, a visual field test, and a color vision test to ensure that there are no other abnormalities.[1] Advanced methods like Optical coherence tomography (OCT) and Frequency Doubling Perimetry (FDP) can also be chosen if needed.[1]
Types
[edit]Bilateral or binocular blindness
[edit]Patients may simulate bilateral or binocular blindness. The general behavior of the patient is important in assessing this. If the patient easily enters and walks around the exam room without hesitation, it is a sign of malingering. If a person claims he has bilateral visual impairment, many tests can be done to see if he is lying.
Eye contact effect, identifying and avoiding ostrucles, unable to sign when asked, closing their eyes when a hand is suddenly waved towards the patient's face, following mirror image are some common behaviors a malingerer shows.[1] Reading eye chart and gradually increase the size of the letters and ask the patient to read them and testing with a zero power lens in a trial frame may also be used in malingering.[8]
In general, near vision decreases in proportion to the decrease in distance vision. A large discrepancy between near visual acuity and distance acuity indicates that the problem is not organic.[1] Other tests like Optokinetic response, Psychogalvanic test and Preferential looking test, a test that is commonly used to test visual acuity in infants may be used to determine malingering in adults.[9][1]
Uniocular blindness or visual impairment
[edit]If a person claims that he has defective vision or no vision at all in one eye, if there are no other signs, tests like Convex Lens Test, Prism base down test, Duochrome test, cycloplegic test, etc. can be done to see if the person is malingering.[2][8]
If there is no refractive error or media opacity that cause disparity in visual acuity between the two eyes, and if there is a true pathology is present, the affected eye may have a Relative afferent pupillary defect.[1]
Visual field defects
[edit]If a person claims that he has defective visual field, if there are no other signs, automated or manual visual field tests including Confrontation testing can be used to rule out defects in the field of vision.[4]
Night blindness
[edit]A person who does not have night blindness may sometimes claim to have night blindness. People may do this to avoid doing certain types of work, to avoid night shifts, to escape police cases etc.[4] Full field Electroretinography is test used to determine if the patinet is simulationg or not. If combined responses from rods and cones are normal in this test, it may be considered as simulation.[4] Irregular or missed responses may be noticed in other tests like Dark adaptometry and Blue and red discs test.[4]
Colour blindness
[edit]A person have color blindness may sometimes claim to have normal color vision. People can do this to get certain types of jobs that reject color blind people. Tests like Ishihara test, Farnsworth 100 hue, 15 hue tests and anomaloscope can be used in this.[4]
Simulating an eye disease
[edit]Apart from visual problems, sometimes a person may pretend to have a symptom of a disease that they do not have, mimic the symptoms of a disease, exaggerate the symptoms of a mild illness, or create a real illness through self-inflicted injury or mechanical or chemical use.[10]
Recording
[edit]Although malingering is not a medical diagnosis, it may be recorded as a "focus of clinical attention" or a "reason for contact with health services".[11][12]
History
[edit]Most cases of visual malingering recorded in history are found in military records, as it was mostly used to avoid mandatory tasks.[13] Malingering was recorded among the Roman legions.[13]
References
[edit]- ^ a b c d e f g h i j k l Incesu, AI; Sobacı, G (2011). "Malingering or simulation in ophthalmology-visual acuity". International journal of ophthalmology. 4 (5): 558–66. doi:10.3980/j.issn.2222-3959.2011.05.19. PMID 22553721.
- ^ a b c Khurana, A. K. (2019). Comprehensive ophthalmology (Seventh ed.). New Delhi. p. 344. ISBN 9789352706860.
{{cite book}}: CS1 maint: location missing publisher (link) - ^ a b c d "Functional Visual Loss - EyeWiki". eyewiki.aao.org.
- ^ a b c d e f Incesu, Ali Ihsan (2013). "Tests for malingering in ophthalmology". International Journal of Ophthalmology. 6 (5): 708–717. doi:10.3980/j.issn.2222-3959.2013.05.30. ISSN 2222-3959.
- ^ Quam, Karin (1 January 1974). "Ocular Malingering". American Orthoptic Journal. 24 (1): 73–76. doi:10.1080/0065955X.1974.11982350. ISSN 0065-955X.
- ^ Manion, Garrett N.; Stokkermans, Thomas J. (2025). "Nonorganic Vision Loss". StatPearls. StatPearls Publishing.
- ^ Dinghal, N. C. (December 1972). "Hysterical blindness versus malingering". Indian Journal of Ophthalmology. 20 (4): 173–178.
- ^ a b "Functional Visual Loss". webeye.ophth.uiowa.edu. Archived from the original on 2023-07-04. Retrieved 2023-04-20.
- ^ Fahle, M.; Mohn, G. (1 August 1989). "Assessment of visual function in suspected ocular malingering". British Journal of Ophthalmology. 73 (8): 651–654. doi:10.1136/bjo.73.8.651. ISSN 0007-1161.
- ^ Enzenauer, Robert; Morris, William; O’Donnell, Thomas; Montrey, Jill (2014). "Ocular Malingering". Functional Ophthalmic Disorders: Ocular Malingering and Visual Hysteria. Springer International Publishing. pp. 55–70. ISBN 978-3-319-08750-4.
- ^ Bienenfield, David (April 15, 2015). "Malingering". Medscape. WebMD LLC. Archived from the original on December 30, 2016. Retrieved December 30, 2016.
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), malingering receives a V code as one of the other conditions that may be a focus of clinical attention.
- ^ "QC30 Malingering". ICD-11 for Mortality and Morbidity Statistics. International Classification of Diseases (11th ed.). World Health Organization. April 2019. Retrieved November 5, 2019.
- ^ a b Ballard, Brad; Enzenauer, Robert W. (2019). "Historical Perspectives on Ocular Malingering" (PDF). Historia Ophthalmologica Internationalis. 2: 315–319.