Pattern-reversal visual evoked potentials as a diagnostic tool for ocular malingering

Area of Science:

• Ophthalmology
• Neuroscience
• Clinical Electrophysiology

Background:

• Ocular malingering, the intentional simulation of vision loss, poses diagnostic challenges.
• Accurate diagnosis is crucial for appropriate patient management and to prevent unnecessary treatments.

Purpose of the Study:

• To evaluate the utility of transient pattern-reversal visual evoked potentials (VEP) in diagnosing ocular malingering.
• To assess the VEP's ability to differentiate genuine vision impairment from feigned visual deficits.

Main Methods:

• Retrospective analysis of 20 adult patients with suspected ocular malingering.
• Comparison of distance optotype visual acuity with transient pattern-reversal VEP parameters (P100 latency and amplitude).
• VEP testing utilized checkerboards with 15' and 60' visual subtenses.

Main Results:

• In 8 patients (40%), reduced visual acuity was accompanied by normal VEP parameters, indicating pure malingering.
• In 12 patients (60%), VEP results were inconsistent with reported visual acuity, suggesting exaggeration.
• Financial motivation was a common factor in 90% of the cases.

Conclusions:

• Transient pattern-reversal VEP is a valuable tool for assessing visual pathway integrity in suspected ocular malingering.
• Normal VEP findings in patients with reported visual impairment strongly suggest malingering.
• This electrophysiological technique aids in objective diagnosis when subjective visual acuity reports are unreliable.